Managed CareNURSE CLINICAL CODER ANALYST MidAtlantic $50 - 65K
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Conduct clinical audits of RAPS and encounter data to ensure that the medical record substantiates what is submitted to the Centers for Medicare and Medicaid Services (CMS) and the state agency responsible for medical assistance benefits (DPW). Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis code based on service rendered and medical record review. Review medical record information to identify all appropriate coding based on CMS Coding Guidelines. Document and communicate findings to various internal staff and staff within the provider's office. Develop written materials for internal staff and the provider community regarding correct coding practices. |
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Required Qualifications |
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High School Diploma or GED. Five (5) years of clinical nursing experience. Five (5) years coding experience in either an in-patient setting or medical office environment. Three (3) years experience in auditing medical records. Registered Nurse. Certified Medical Coder (CPC, CPC-P) or (CCS, CCS-P). Member of AAPC or AHIMA. |
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Preferred Qualifications |
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Bachelor's or Master's degree in Nursing or Business Administration or Information Systems. Three (3) years of data analysis related to medical records review.
CONTACT: Jerry Waering 800 489 3602 ext. 1 or jerryw@readwaering.com
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Clinical Coder Analyst
Job ID# 59019
Location: Pittsburgh, PA |
QI CONSULTANT NURSE MIDATLANTIC $45 - 60K
Conducting medical record reviews, including audits for compliance with medical record standards, those related to any clinical studies including HEDIS and EQRO activities, and evaluation of quality of care concerns. Assisting in the coordination and implementation of the Quality Improvement Programs and initiatives. Assisting in the preparation of any internal auditing, external accreditation survey or external state or federal regulatory compliance audit reviews, including document preparation and analysis for compliance. Development of clinical and preventive guidelines and studies, analysis of data and associated barriers and opportunities and coordination with internal and external customers to develop effective action plans based on findings. Coordination and collaboration with other company departments, committees and physician work groups for activities related to assigned quality improvement activities. Auditing of processes performed by other company departments and delegates per accrediting, governmental and regulatory requirements.
REQUIRED QUALIFICATIONS: A Nursing or Diploma. Three (3) years of nursing experience with Quality Improvement or Utilization Management in a managed care health plan environment. Pennsylvania RN License.
PREFERRED QUALIFICATION: Bachelor's degree in Nursing. Managed care health plan experience in Medicaid / Medicare. Knowledge of NCQA Standards. Strong analytical and problem solving skills with the ability to understand and interpret data. Proficiency using Microsoft Outlook, Word and Excel. Basic skills using Microsoft PowerPoint, Access and Visio.
CONTACT: Jerry Waering 800 489 3602 ext. 1 or jerryw@readwaering.com
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Security Officer MidAtlantic $75 – 90K +
Job Responsibilities Summary |
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Assure drafting implementation and on-going operations of all facets of company's Security Program as defined in HIPAA standards for General Security Standards, Administrative Safeguards and Physical Safeguards, as those terms are used in federal regulations at 42 CFR 164.306 through 164.310 (inclusive of revisions or additions to these sections that occur from time-to-time). Assure compliance with Information Technology ("IT") Security elements of company's Security Program including policy adoption; security awareness and training; review of security and privacy breach incidents and associated investigations; risk assessments and on-going monitoring; and implementation/monitoring of security-related corrective action plans.
Develop Minimum Security Baselines (MSBs) for all components of company's data security. Work closely with peers in Corporate Compliance, internal department management, company’s Senior Management and third party entities to identify risks or areas of opportunity for improved processes, policies and education with respect to data and physical security. Develop security and privacy requirements and act as a resource for questions regarding related to information protection, security and confidentiality (includes, but is not limited to, IT and physical security management, security vulnerability monitoring and security event intervention for healthcare information systems, databases, software programs, legacy servers, desktop servers, electronic submissions, remote users and physical security). Research and analyze changes in laws/regulations to determine impact to current business environment and as applicable to new, or changing, business initiatives. Evaluate HIPAA, ARRA and HITECH security and privacy compliance through: policy reviews, gap assessments, mock audits, analysis of issues, industry trends or benchmarks, risk assessments and remediation plans. Establish a program of on-going monitoring of federal and state security law compliance, including HIPAA, ARRA and HITECH with periodic assessments that assure continuing compliance with Medicare and Medicaid requirements for program security. Act as lead investigator for all potential breach situations, identify those requiring notification and coordinate actions throughout the organization.
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Required Qualifications |
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Minimum 5 yrs IT or health record security experience including experience developing privacy and/or safety features and related policies. Bachelor's degree or 5 years of related healthcare experience. Proficient using business tools such as: Excel, PowerPoint, Microsoft Word. Proficient using business tools such as: Excel, PowerPoint, Microsoft Word. Ability to travel to third party locations within U.S. as needed. |
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Preferred Qualifications |
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Advanced degree. Three (3) years implementing CMS regulatory requirements and HIPAA privacy standards; demonstrated understanding of implications of non-compliance with regulations, bulletins, contracts, standards etc. Two (2) years experience performing auditing/monitoring functions. Two (2) years handling data privacy, compliance, risk management, investigations. Experience presenting complex materials to a variety of audiences. Twp (2) yrs experience creating tools, training documents and educational materials geared to adult learners. Working knowledge of the HIPAA Security Rule and Security Series papers. Working knowledge of the National Institute of Science and Technology Special Publications (NIST 800-66: An Introductory Resource Guide for Implementing the Health Insurance and Portability and Accountability Act; and 800-53: Recommended Security Controls for Federal Information Systems). Experience initiating and monitoring corrective action plans (CAPs). Experience with Quality Improvement/Measurement methodologies. Certified Information Privacy Professional (CIPP), with special consideration to those achieving either the Information Technology (CIPP/IT) or Government (CIPP/G) designation.
Contact: Jerry Waering 800 489 3603 ext. 1 or jerryw@readwaering.com | |
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