Auditing non administration operations including clinical facilities to evaluate compliance with applicable regulatory requirements Developing, implementing, and monitoring of EOHS programs, plans and policies to ensure compliance with applicable, federal, state, and local EHS laws, rules and regulations, ordinances, and standards Ensuring all managed facilities comply wi

Auditing non administration operations including clinical facilities to evaluate compliance with applicable regulatory requirements Developing, implementing, and monitoring of EOHS programs, plans and policies to ensure compliance with applicable, federal, state, and local EHS laws, rules and regulations, ordinances, and standards Ensuring all managed facilities comply wi

Create, manage, and respond to support tickets submitted by customers experiencing challenges with Contact center platform Provide exceptional omnichannel customer support by gathering and interpreting customer challenges Act as a technical liaison or subject matter expert in supporting cross functional issues Support the Technical Support Specialist in advanced trouble s

Perform research which advances the state of the art in AI and ML Implement algorithms and evaluate their performance on healthcare data Communicate results across an interdisciplinary team and explore use cases which improve real world healthcare outcomes Document research internally and externally, including publications in machine learning and other scientific conferen

Conducts in bound and out bound calls for program requirements including, but not limited to medication adherence member outreach calls, reminder calls, prescription refill calls and provider follow up calls in a call center environment Completes calls/assignments and ensures census management, productivity weekly and monthly standards are met Exhibits excellent phone and

Lead a high performing, multi disciplinary global engineering team of 700+ engineers across web, mobile and portal solutions Define the digital technology strategy for end to end omni channel digital experiences Formulate and lead both near term and long term digital product development strategies and ongoing deliveries Create high performing product model across all disc

Leadership responsibilities Manage all aspects of the P&L, including driving growth, reducing medical expense, STARs performance, coding accuracy and administrative cost efficiency Lead the strategy creation and implementation, spanning assets in the benefit and care delivery space Organize the current businesses into a cohesive unit to deliver best in class integrated me

Investigate instances of potential healthcare fraud, waste, and/or abuse (FWA) Conduct telephonic and/or in person interviews of members, providers, and other related parties to gather information in support of investigations Review and analyze claims data to identify patterns and indications of potential FWA Conduct onsite provider investigations for claim and/or clinica

Conduct MS DRG and APR DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification Expert knowledge of and the ability to identify the ICD 10 CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD 10 Official

Identify appropriate assignment of ICD 10 CM and ICD 10 PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Identify appropriate assignment of CPT and ICD 10 Codes for outpatient sur

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Careers with MedExpress. At MedExpress, we believe in delivering quality, convenient, affordable health care and exceeding our patients' expectations. Our neighborhood medical centers are open every day from 8 8 with a full medical team and no appointments necessary to help patients get in, get healthy, and get back to what's really important . We provide a broad scope of

Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing or physician assistants Establishes and maintains effective relationships with patients, care givers, and/or their legal representatives, IDT members, PCPs, other collaborating physicians/providers, and facility staff when applicable Performs an initi

Perform remote and onsite hospital bill charge audits as assigned while meeting department quality expectations Manage case inventory to ensure timely scheduling of remote and onsite audits while maintaining weekly productivity goals Ability to assess case details and provide input into audit potential of facilities & cases Effectively interact and communicate with teamma

Identify appropriate assignment of CPT and ICD 10 Codes for outpatient surgery, observation, CVIR, emergency, and ancillary services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Apply coding knowledge to analyze/correct CCI Edits and Medical Necessity accounts Understand the Medicare Ambulatory Payment