Policy Analyst Salary in Nashville, TN

Credit Balance Analyst should possess a thorough working knowledge of the revenue cycle management process. Responsibilities include working closely with Department Supervisor to ensure that refunds are processed accurately and timely in order to promote customer loyalty. The Credit Balance Analyst is responsible for review, correction, resolution of all account credit balances. This position must be a role model and demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion and safety of others. High school diploma 2+ years of experience in medical billing and collections in an outpatient setting 2+ years of cash application experience 2+ years of credit balance resolution experience Strong computer skills with Microsoft Office Suite Strong analytical and problem-solving capabilities Excellent planning and organization skills with close attention to detail Self-motivated, with ability to work independently and with a team. Ability to remain flexible during times of change and adjusts promptly and effectively Ability to read and interpret Explanation of Benefits (EOB's) Knowledge and understanding of accounting principles and healthcare billing and collection practices Working knowledge of revenue cycle management Excellent mathematical aptitude and basic accounting skills Identify research and review accounts with credit balances. Transfer credits when appropriate within a patient or guarantor account. Post all un-posted and misapplied patient payments. Review and resolve all patient/guarantor addresses issues. Initiate all patient and insurance refunds. Escheat balances according to corporate policy. Send weekly refund report to supervisor for review and approval. Post credit balance adjustment for all approved refunds. Meet production and quality expectations outlined by management. Balance all refund batches on a daily basis. Evaluate processes within area of responsibility in order to recommend and participate in process improvement initiatives. Must be able to perform the essential functions of this position with or without reasonable accommodation.

Job DetailsSUMMARYHSAG is nationally recognized as an industry leader in the areas of healthcare data analysis, measure development, and survey research. We are in search of talented individuals who are interested in a career in analytics as an Analyst I in HSAG's Data Science & Advanced Analytics division. Together we can spread positive change to make healthcare better. UNIQUE BENEFITSThe Analyst I position benefits from HSAG's desire to grow its staff into leaders of healthcare quality improvement in the nation. During the first year, new HSAG analysts are provided formal internal training in statistics, machine learning, clinical epidemiology, SAS, Tableau, healthcare data, and an assortment of healthcare-related topics. The Analyst I will also have the opportunity to participate in company-sponsored training with the SAS Institute.HSAG offers:A comfortable work-life balance, including half-day Fridays and flexible work schedules.Three weeks of paid time off and 15 company-paid holidays where staff leave two hours early prior to each holiday to get a "jump start" on holiday festivities.HSAG offers a competitive benefit package that includes medical, dental, vision, tuition reimbursement, and 401(k). DESCRIPTIONThe Analyst I position is a key contributor to cutting-edge analytic work that spans the broad spectrum of healthcare data projects at HSAG. Driven by intellectual curiosity and a passion for healthcare quality, the Analyst I position supports innovative analytic plans that are intended to provide healthcare decision and policy makers with the necessary information to transform healthcare. HSAG analysts within the Data Science & Advanced Analytics division assist in designing a wide array of analytic studies and participate in all phases of the research design process. Analysts may work with a wide array of data to facilitate data exploration, including (but not limited to) the following data types:surveycase reviewmedical and prescription drug claims and encounterseligibilitydemographicclinicalelectronic health recordregistryvital statisticsoperationalDetails regarding potential project assignments and key sources of data will be discussed with candidates during the interview process.ESSENTIAL COMPETENCIES, DUTIES, AND RESPONSIBILITIESServe as an integral part of HSAG Data Science & Advanced Analytics division.Exhibit the ability to learn about the primary types of healthcare data and methods for approaching data assessments.Exhibit the ability to learn efficient SAS programming skills.Evaluate a wide array of data types.Conduct and interpret analyses, develop appropriate statistical models, manipulate complex databases, and track and evaluate patterns of care and outcomes.Perform data validation, conduct analysis plans, and cross reference data.Attend and participates in team training meetings.Present and communicate project results to nonanalytic staff members and customers. Represent HSAG in a professional manner at all times.Compensation: $70,000 - $75,000 - Depending upon experienceJob Requirements:EDUCATION AND/OR EXPERIENCEBachelor's degree in a quantitative discipline (e.g., math, statistics, economics, and epidemiology). Master's degree preferred. OTHER QUALIFICATIONSCoursework completed in statistics and other quantitative coursesKnowledge of statistical programming in at least one software language.Experience working with relational databases.Proficient in Microsoft Word and Excel.Excellent verbal and written communication skills.Ability to handle several projects simultaneously and work with multiple teams.WORK ENVIRONMENTThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.DISCLAIMERThis is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts or working conditions associated with the position. While this is intended to be an accurate reflection of the current position, management reserves the right to revise the position or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, work load, rush jobs requiring non-regular work hours, or technological developments).HSAG is an EEO Employer of Veterans protected under Section 4212. If you have special needs and require assistance completing our employment application process, please feel free to contact us.EOE M/F/Vet/DisabledGet job alerts by email.Sign up now!

Job DetailsSUMMARYHSAG is nationally recognized as an industry leader in the areas of healthcare data analysis, measure development, and survey research. We are in search of talented individuals who are interested in a career in analytics as an Analyst III in HSAG's Data Science & Advanced Analytics division. Together we can spread positive change to make healthcare better. UNIQUE BENEFITSThe Analyst III position benefits from HSAG's desire to grow its staff into leaders of healthcare quality improvement in the nation. During the first year, new HSAG analysts are provided formal internal training in statistics, machine learning, clinical epidemiology, SAS, Tableau, healthcare data, and an assortment of healthcare-related topics. The Analyst III position also offers the opportunity to mentor and supervise junior-level staff.HSAG offers:A comfortable work-life balance and flexible work schedules.Three weeks of paid time off and 15 company-paid holidays where staff leave two hours early prior to each holiday to get a "jump start" on holiday festivities.HSAG offers a competitive benefit package that includes medical, dental, vision, tuition reimbursement and 401(k). DESCRIPTIONThe Analyst III position is a key contributor to cutting-edge analytic work that spans the broad spectrum of healthcare data projects at HSAG. Driven by intellectual curiosity and a passion for healthcare quality, the Analyst III position helps lead components of innovative analytic plans that are intended to provide healthcare decision and policy makers with the necessary information to transform healthcare. HSAG analysts in the Data Science & Advanced Analytics division assist in designing a wide array of analytic studies and participate in all phases of the research design process. Analysts may work with a wide array of data to facilitate data exploration, including (but not limited to) the following data types:surveycase reviewmedical and prescription drug claims and encounterseligibilitydemographicclinicalelectronic health recordregistryvital statisticsoperationalDetails regarding potential project assignments and key sources of data will be discussed with candidates during the interview process.ESSENTIAL COMPETENCIES, DUTIES, AND RESPONSIBILITIESServe as an integral part of HSAG Data Science & Advanced Analytics division.Lead small- to medium-sized analytic tasks or projects, while providing support to other analytic tasks or projects.Understand primary types of healthcare data and methods for approaching data assessments.Evaluate a wide array of data types.Conduct and interpret analyses, develop appropriate statistical models, manipulate complex databases, and track and evaluate patterns of care and outcomes.Perform data validation, develop and implement analytic plans, and cross reference data.Attend, participate, and assist in team training meetings.Present and communicate project results to nonanalytic staff members and customers. Represent HSAG in a professional manner at all times.Compensation: 85000 Based on ExpJob Requirements:EDUCATION AND/OR EXPERIENCEBachelor's degree in a quantitative discipline (e.g., math, statistics, economics, and epidemiology). Master's degree preferred. A minimum of four (4) years of work experience.At least three (3) years of healthcare experience.At least three (3) years of statistics and/or quantitative analysis experience.OTHER QUALIFICATIONSExpert in the use of SAS software for statistical programming. SAS certification preferred.Proficient in the use of SQL.Experience working with relational databases.Experience contributing to report writing and formal written deliverables, including serving as the lead writer/major contributor to a formal written deliverable.Some proposal experience in a supporting role.Some experience mentoring junior-level staff.Proficient in Microsoft Word and Excel.Excellent verbal and written communication skills.Ability to handle several projects simultaneously and work with multiple teams.WORK ENVIRONMENTThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.DISCLAIMERThis is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts or working conditions associated with the position. While this is intended to be an accurate reflection of the current position, management reserves the right to revise the position or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, workload, rush jobs requiring non-regular work hours, or technological developments).HSAG is an EEO Employer of Veterans protected under Section 4212. If you have special needs and require assistance completing our employment application process, please feel free to contact us.EOE M/F/Vet/DisabledGet job alerts by email.Sign up now!

Our client is a large-scale healthcare provider. They have over four decades of experience providing pharmacy, clinical, and nonclinical care to patients both at home and throughout their community. They focus on quality, innovation, and improving their community as a whole. They are looking for a Revenue Cycle Integrity Analyst to join their growing team. In this role, you will serve as the process owner for payer plan maintenance, managing contracts across various lines of business. This includes collaborating with operational and IT teams to ensure accurate communication and education regarding payer contracts and rate changes. This Role Offers: Competitive base salary plus comprehensive benefits, including medical/dental/vision, 401(K), and more. Stable company with over seven decades of experience. Tight-knit culture focused on taking care of their employees. Ample opportunities for growth and career advancement. High employee tenure with low red tape culture. They hire professionals and trust their expertise, giving them room to make tangible impacts. Focus: Serve as the process owner for payer plan maintenance, managing contracts for various lines of business. Maintain an up-to-date repository of payer contracts, amendments, and renewals. Audit contracts prior to movement into the production contract management system. Translate payer contracts into a shared site for tracking and reference. Analyze and resolve specific billing edits/errors delaying claims processing. Ensure accurate payer setup and contractual allowance calculation in multiple billing systems. Collaborate with cross-functional teams to ensure correct interpretation and timely loading of contracts. Conduct in-depth analysis of payer contracts, identifying opportunities for system improvements. Assist with fee schedule negotiations and value-based care initiatives. Stay current on healthcare regulations and reimbursement policies. Generate comprehensive reports and conduct data analysis to track contract performance and financial outcomes. Present findings and recommendations to management for informed decision-making. Skill Set: Bachelor's degree in Accounting, Business, or related field preferred. 3+ years of experience in contract management, reimbursement methodology, or payer relations. Prior experience in contract negotiation and management plus knowledge of healthcare compliance and regulations. Strong knowledge of payer contracts, healthcare reimbursement methodologies, and regulations. Proficiency in healthcare revenue cycle software and data analytics tools. Exceptional communication, negotiation, and relationship-building skills paired with the ability to work independently and collaboratively in a team. Analytical mindset with problem-solving capabilities and detail-oriented with strong organizational skills. Must reside within the following locations: Arizona, Kentucky, Texas and Tennessee. About Blue Signal: Blue Signal is a leading executive search firm specializing in healthcare recruiting. Our healthcare recruiters have expertise in placing high-performing talent in healthcare IT, medical devices, biotechnology, pharmaceuticals, etc. Learn more at bit.ly/3G5DbWr

As the #1 advisor for developing and empowering people to deliver the highest quality care, HealthStream's brands include best-in-class apps, software, and specialized solutions. Over the last 30+ years, our Company has remained committed to solving big problems and growing into new product lines. We are constantly innovating and finding new ways to positively impact healthcare organizations. What does our values-based culture offer you? A collaborative work environment A mission-oriented mindset Work-from-home flexibility A chance to grow your career All our HealthStreamers share a common vision: to improve the quality of healthcare by developing the people who deliver care. For over 30 years, we have remained committed to providing effective solutions through innovation and constant growth. Today, we offer a unified suite of products to streamline scheduling, credentialing, training and learning management, workforce development, and other key areas in the healthcare industry. We provide recurring value and, as a HealthStreamer, you will be at the forefront of healthcare technology innovation! We offer work-from-home flexibility as part of our hybrid workplace policy. Our three Resource Centers (located in Nashville, TN; Boulder, CO; and San Diego, CA) are available for scheduled in-person events or assigned workspaces for those who want to work in the office. Remote team members also have access to flexible space scheduling for occasional use. We encourage collaboration and commit to growth for our entire team. Our thriving culture allows our team members to continuously solve big problems, and we value these contributions. If you want to work for a company committed to its values and vision, HealthStream is the place for you! We make sure patients receive competent care from qualified people. As a HealthStream team member, you would help this vision come to life. We pride ourselves on being a community where you can both build your career and take time away to fulfill your life goals and commitments. Your Role As a HealthStreamer Position Summary The GRC Analyst will plan and audit policies, procedures, standards, and controls that govern the protection of corporate information systems, networks, and data. The GRC security analysts will stay up-to-date on the latest cybersecurity intelligence, including hackers' methodologies, in order to identify standards and controls that should be considered across the organization. Additionally, the GRC Analyst will be responsible for adhering to all HealthStream security policies, procedures, and assigned training. Essential Duties and Responsibilities You will be responsible for adhering to all HeathStream security policies, procedures, and assigned training. Performing control assessments against corporate cybersecurity framework Perform review of policies and supporting procedures/processes Perform assessments of adherence to standards Work closely with management on security practices Assess 3rd party vendors for adherence to standards Develop routine reports in accordance with GRC metrics Stay on top of changes in the industry as it relates to security. Other duties as assigned. Qualifications What You Will Need to be Successful Education, Experience and Knowledge Required Bachelor's Degree, ideally in Computer Engineering, Computer Science, or Information Systems Management or equivalent work experience in the field of Cybersecurity Possess current security certifications (e. g., Security+, CISSP, CEH, SANS) or be willing to obtain within 1 year of assignment Understanding and familiarity with information system standards Understanding and familiarity with cybersecurity frameworks (e.g., ISO, NIST, HITRUST, COBIT) Assist in performing IS self-assessments to ensure systems and applications are complying with corporate policies, applicable regulatory and legal requirements, and leading industry practices. Works with the CISO to determine the acceptable level of risk for enterprise computing platforms. Assist in performing Third Party Risk Assessments for new and existing vendor tools, on premise implementations, and third parties with access to the environment. Assist in maturing the Third-Party Risk Management program by defining security controls based on tiers of vendors. Skills and Abilities Required Drive innovation by analyzing and interpreting data to test and inform a new initiative or approach. Accountable for successful completion of multiple, individual projects simultaneously. Communicate effectively by contributing significantly to the development and delivery of a variety of written and visual documents for diverse audiences. Manage change and demonstrate adaptability by embracing change and adjusting priorities or processes and approach as needs dictate. Take responsibility for successes and failures related to individual and team-based project work assignments; actively presents suggestions for solution(s), if objectives not met. Benefits HealthStream offers a comprehensive benefits package to eligible employees, including: Medical, Dental and Vision insurance Paid Time Off Parental Leave 401k and Roth Flexible Spending Account Health Savings Account Life Insurance Short- and Long-Term Disability Medical Bridge Insurance Critical Illness Insurance Accident Insurance Identity Protection Legal Protection Pet Insurance Employee Assistance Program Fitness Reimbursement If you have a passion for improving healthcare outcomes and empowering healthcare workers, come join the HealthStream team! We hope you join us and be a HealthStreamer!

We are seeking a candidate with strong HRIS systems experience to join for a contract opportunity. The Workday Business Systems Analyst is responsible for ensuring the setup and configuration of all HR Technology-Workday. Manage configuration for Workday, Compensation, Advanced Compensation and Recruiting modules. This is a fully remote opportunity. The resource in this role must be able to work Eastern time hours. Contract Duration: 7 monthsRequired Skills & ExperienceStrong working knowledge of HRIS systems. Workday Ecosystems experience required.High-level understanding of business functions/end-to end processes, strategic imperatives, and project management.Strong business case mentality.Demonstrated consultative skills and ability to effectively facilitate groups to consensus. Ability to create trust and confidence quickly.Ability to exercise independent judgment and creative problem-solving techniques in a highly complex environment using leading-edge technology.Ability to communicate effectively both verbally and in writing; ability to communicate with customers, associates, and management; solid teamwork and interpersonal skills.Ability to present and discuss strategies and technical information in a manner that establishes rapport, persuades others, and establishes understanding for technical and non-technical audiences.Strong business planning, analytical, and conceptual skills to evaluate business problems and apply knowledge to identify appropriate solutions.Well-developed organizational and time management skills; attention to detailAbility to develop and deliver training methodologies and materials.Bachelor's Degree Desired Skills & ExperienceWhat You Will Be DoingDaily ResponsibilitiesActs as Systems Administrator for HR technology, which may include HRMS, ATS, Talent Management and HR Portal technology (telephony, case management, knowledge management) by addressing system problems and enhancing system functionality.Partners with Stakeholders which may include HR, associates, and vendors to determine strategic needs, defines functional/technical specifications, troubleshoot issues, and implement initiatives.Utilizes complex reporting tools to develop, document and monitor cross-process data integration points in future-state business process designs, facilitate resolution of misalignment across process areas.Supports teams in identification, analysis and implementation planning of optimizing design, cleansing legacy data, and prioritizing conversion of integrated data.Develops and manages the business process designs and accuracy of associate information such as company data, location data, position data, custom fields, parent/child relationship, etc.Operates as the key liaison with the HR, Accounting/Finance, Internal/External Auditors for SOX compliance issues or new company, locations, departments, etc. set up.Develops and manages the audit process for associate information; work directly with the HR, Benefits, Payroll, Accounting/Finance, IT management teams to provide data integrity, consistency, and reliability throughout the organization.Develops recommendations for process improvements related to data utilization and maintenance.Performs testing responsibilities, including reviewing specifications, creating test scenarios, and overseeing testing of the system.Manages deployment and testing of system patches/new releases.Provides system updates and enhancement recommendations to Stakeholders.Provide and maintain associate training materials.Responsible for developing, implementing, and maintaining associate master data standards and appropriate legal compliance and company policy.Serves as Tier 2 Specialist to resolve complex technical issues raised by associates and managersMaintains and develops a strong working relationship with business owners as a process advocate.Maintains appropriate issue tracking and manage issue resolution process. Supports the development of specific actions and recommendations to mitigate risk and resolve outstanding issues.Creates, maintains, and delivers status reporting for related project activities to key stakeholders.Performs related duties as assigned.Best Regards,Kshitija Karpate | SENIOR RECRUITMENT LEAD - DIRECT HIREOFFICE (678) 855-7388EMAIL [email protected]

Cigna Medicare Part C Appeals Reviewer: Appeals Processing AnalystWe will depend on you to communicate some of our most critical information to the correct individuals regarding Medicare appeals and related issues, implications and decisions.The Case Management Analyst reports to the Supervisor/Manager of Appeals and will coordinate and perform all appeal related duties in a Medicare Advantage Plan. These appeals will include requests for decisions regarding denials of medical services as well as Part B drugs. The Case Management Analyst will be responsible for analyzing and responding appropriately to appeals from members, member representatives and providers regarding denials for services and denials of payment via oral and written communication; researching and applying pertinent Medicare and Medicaid regulations to determine the outcome of the appeal; provide oversight and assistance to Medical Management staff with resolution of appeal by interpreting Medicare and Medicaid regulations; reviewing documentation to ensure that all aspects of the appeal have been addressed properly and accurately; e) prepare case files for submission to Independent Review Entity, which also include writing required case summary on behalf of the plan to support appeal resolution.This position is full-time (40 hours/week) with the scheduled core business hours generally 7:00 am - 6:00 pm CST - Thursday through Sunday with occasional holiday coverage. The position requires 4 ten hour shifts per week. Job Requirements include, but not limited to: Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part CAbility to differentiate different types of requests Appeals, Grievances, coverage determination and Organization Determinations in order to ensure the correct processing of the appeal.Excellent prioritization and organizational skills; effectively manage competing priorities and multiple deadlines.Review, research and understand how request for plan services and claims submitted by consumers (members) and physicians/providers was processed and determine why it was deniedIdentify and obtain all additional information (relevant medical records, contract language and process/procedures) needed to make an appropriate determination of the appeal.Make an appropriate administrative determinations as to whether a claim should be approved or denied based on the available information and as well as research and provide a written detailed clinical summary for the Plan Medical Director. Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal rights are applicable and then if necessary, route to the proper area/department for their review and decision/responseComplete necessary documentation of final documentation of final determination of the appeals using the appropriate system applications, templates, communication process, etc.Communicate appeal information to members or providers with the required timeframes well as to all appropriate internal or external parties (regulatory agencies, plan administrators, etc.)Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendanceAdhere to department workflows, desktop procedures, and policies.Work with all matrix partners to ensure accurate and timely processing of Medicare Appeals.Read Medicare guidance documents report and summarize required changes to all levels department management and staff.Support the implementation of new process as needed.Based on case work and departmental reporting, ability to identify and report trends and/or areas of opportunities to department management and peers. .Understand and investigate billing issues, claims and other plan benefit information. .Assist with monitoring, inquiries, and audit activities as needed.Additional duties as assigned.QualificationsEducation: Licensed Practical Nurse (LPN) or Registered Nurse (RN)3-5 years' experience in Medicare Advantage Health Plans or related experience in a healthcare setting handling complex inquiries and requests for serviceWorking knowledge of Medicare Advantage, Original Medicare and or Medicaid appeal regulations. Understanding of Local Coverage Determinations, National Coverage Determinations, Medicare claim process and plan rules along with working with of ICD9, ICD10Superb written and oral communication skills with particular emphasis on verbally presenting case summary and decisions.Must have the ability to work objectively and provide fact based answers with clear and concise documentation.Proficient in Microsoft Office products (Access, Excel, Power Point, Word).Prioritizes workflow on a consistent basis, applies key HIPAA and CMS guidelines in daily workflow, and meets turnaround times for assigned cases.Ability to multi-task and meet multiple competing deadlines.Ability to work independently and under pressure.Attention to detail and critical thinking skills..Learning and Applying QuicklyA relentless and versatile learnerOpen to changeAnalyzes both successes and failures for clues to improvementExperiments and will try anything to find solutionsEnjoys the challenge of unfamiliar tasksQuickly grasps the essence and the underlying structure of anythingWritten CommunicationsIs able to write clearly and succinctly in a variety of communication settings and stylesCan get messages across that have the desired effectFunctional/Technical SkillsClinical and Non Clinical functional or technical proficiencyAppropriate judgment and decision making becauseKnowledge of applicable policy and business requirementsComputer skills and ability to work in various system applications.Detail oriented and Has the functional and technical knowledge and skills to do the job at a high level of accomplishmentTime ManagementSpends his/her time on what's importantQuickly zeros in on the critical few and puts the trivial many asideCan quickly sense what will help or hinder accomplishing a goalEliminates roadblocksUses his/her time effectively and efficientlyConcentrates his/her efforts on the more important prioritiesGets more done in less time than othersCan attend to a broader range of activitiesProblem SolvingUses rigorous logic and methods to solve difficult problems with effective solutionsProbes all fruitful sources for answersCan see hidden problemsLooks beyond the obvious and doesn't stop at the first answersIs excellent at honest analysisIf you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Cigna Medicare Part C Appeals Reviewer: Appeals Processing AnalystWe will depend on you to communicate some of our most critical information to the correct individuals regarding Medicare appeals and related issues, implications and decisions.The Appeals Processing Analyst reports to the Supervisor/Manager of Appeals and will coordinate and perform all appeal related duties in a Medicare Advantage Plan. These appeals will include requests for decisions regarding denials of medical services as well as Part B drugs. The Case Management Analyst will be responsible for analyzing and responding appropriately to appeals from members, member representatives and providers regarding denials for services and denials of payment via oral and written communication; researching and applying pertinent Medicare and Medicaid regulations to determine the outcome of the appeal; provide oversight and assistance to Medical Management staff with resolution of appeal by interpreting Medicare and Medicaid regulations; reviewing documentation to ensure that all aspects of the appeal have been addressed properly and accurately; e) prepare case files for submission to Independent Review Entity, which also include writing required case summary on behalf of the plan to support appeal resolution.This position is full-time (40 hours/week) with the scheduled core business hours generally 8:00 am - 5:00 pm CST - Monday through Friday with occasional weekend and holiday coverage. The position requires 5 eight hour shifts per week. Job Requirements include, but not limited to: Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part CAbility to differentiate different types of requests Appeals, Grievances, coverage determination and Organization Determinations in order to ensure the correct processing of the appeal.Excellent prioritization and organizational skills; effectively manage competing priorities and multiple deadlines.Review, research and understand how request for plan services and claims submitted by consumers (members) and physicians/providers was processed and determine why it was deniedIdentify and obtain all additional information (relevant medical records, contract language and process/procedures) needed to make an appropriate determination of the appeal.Make an appropriate administrative determinations as to whether a claim should be approved or denied based on the available information and as well as research and provide a written detailed clinical summary for the Plan Medical Director. Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal rights are applicable and then if necessary, route to the proper area/department for their review and decision/responseComplete necessary documentation of final documentation of final determination of the appeals using the appropriate system applications, templates, communication process, etc.Communicate appeal information to members or providers with the required timeframes well as to all appropriate internal or external parties (regulatory agencies, plan administrators, etc.)Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendanceAdhere to department workflows, desktop procedures, and policies.Work with all matrix partners to ensure accurate and timely processing of Medicare Appeals.Read Medicare guidance documents report and summarize required changes to all levels department management and staff.Support the implementation of new process as needed.Based on case work and departmental reporting, ability to identify and report trends and/or areas of opportunities to department management and peers. .Understand and investigate billing issues, claims and other plan benefit information. .Assist with monitoring, inquiries, and audit activities as needed.Additional duties as assigned.QualificationsEducation: Licensed Practical Nurse (LPN) or Registered Nurse (RN)3-5 years' experience in Medicare Advantage Health Plans or related experience in a healthcare setting handling complex inquiries and requests for serviceWorking knowledge of Medicare Advantage, Original Medicare and or Medicaid appeal regulations. Understanding of Local Coverage Determinations, National Coverage Determinations, Medicare claim process and plan rules along with working with of ICD9, ICD10Superb written and oral communication skills with particular emphasis on verbally presenting case summary and decisions.Must have the ability to work objectively and provide fact based answers with clear and concise documentation.Proficient in Microsoft Office products (Access, Excel, Power Point, Word).Prioritizes workflow on a consistent basis, applies key HIPAA and CMS guidelines in daily workflow, and meets turnaround times for assigned cases.Ability to multi-task and meet multiple competing deadlines.Ability to work independently and under pressure.Attention to detail and critical thinking skills..Learning and Applying QuicklyA relentless and versatile learnerOpen to changeAnalyzes both successes and failures for clues to improvementExperiments and will try anything to find solutionsEnjoys the challenge of unfamiliar tasksQuickly grasps the essence and the underlying structure of anythingWritten CommunicationsIs able to write clearly and succinctly in a variety of communication settings and stylesCan get messages across that have the desired effectFunctional/Technical SkillsClinical and Non Clinical functional or technical proficiencyAppropriate judgment and decision making becauseKnowledge of applicable policy and business requirementsComputer skills and ability to work in various system applications.Detail oriented and Has the functional and technical knowledge and skills to do the job at a high level of accomplishmentTime ManagementSpends his/her time on what's importantQuickly zeros in on the critical few and puts the trivial many asideCan quickly sense what will help or hinder accomplishing a goalEliminates roadblocksUses his/her time effectively and efficientlyConcentrates his/her efforts on the more important prioritiesGets more done in less time than othersCan attend to a broader range of activitiesProblem SolvingUses rigorous logic and methods to solve difficult problems with effective solutionsProbes all fruitful sources for answersCan see hidden problemsLooks beyond the obvious and doesn't stop at the first answersIs excellent at honest analysisIf you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Classification: Contract-To-HireContract Length: 3-6 Months, highly likely to convert permanentLocation: Hybrid Onsite x2 days @ 2555 Park Plaza, Building 2, Nashville, TN 37203Job ID: #16417250CereCore® provides EHR implementations, IT and application support, IT managed services, technical staffing, strategic IT consulting, and advisory services to hospitals and health systems nationwide. Our heritage is in the hallways of some of America's top-performing hospitals. We have served as leaders in finance, operations, technology, and as clinicians turned power users and innovators. At CereCore, we know firsthand the power that aligned technology can provide in delivering care. As a wholly-owned subsidiary of HCA Healthcare, we are committed to bringing the expertise we have gained as operators to deliver IT services that emphatically address the needs of health systems across the United States. Our team of over 600 clinical and technical professionals has implemented EHR systems in more than 400 facilities and provides managed services support to tens of thousands of health system employees. We work tirelessly to provide healthcare organizations specialized IT services that support the delivery of patient care. The Link to Life-Saving Care.CereCore is seeking a Senior Contract Analyst to join our team in Nashville, TN. In this role you will be responsible for providing business, technical, and legal review and analysis of templated ITG contracts including, but not limited to, order forms, statements of work, non-disclosure agreements (NDA), and business associate agreements (BAA) in support of operations and strategic initiatives of the HCA enterprise. Ideal candidates have 7-8 years of professional experience working on a procurement, buyer, purchasing, contracts or negotiations type team and is comfortable with redlining and negotiating complex contracts with Information Technology vendors and partners including software and IT services providers. Responsibilities This role will be required to utilize the Contract Management System (CMS) to facilitate and execute the ITG contract process as well as perform ongoing CMS maintenance to ensure data integrity.This position requires contracting experience and continued development in the areas of contracting and negotiation with a focus on healthcare information technology subject matter including, but not limited to, professional services, various software licensing methods (on-premise and cloud offerings (Software as a Service, Platform as a Service, and Infrastructure as a Service)), diverse regulatory policies including HIPAA, consumer protection, and GDPR, and information security practices.This position requires keeping up with current technology trends and naming conventions in general and within health care. This position supports the HCA enterprise, including all ITG business units, and reports directly to the Contract Manager. This position works closely with Technology Law Group, Directors, Business Owners, Solution Leaders, Project Managers, Financial Analysts, Strategic Sourcing and occasionally works directly with area VPs and other Executive Management. This position also represents ITG in direct interactions with non-ITG stakeholders, including affiliates such as our group purchasing organization, other HCA enterprise business units and departments, outside counsel, and vendor representatives.This role requires the ability to recognize if / when data is being shared outside of the enterprise, the type of data, and how that data will be utilized.RequirementsBachelor's Degree7-8 years of professional experience working on a procurement, buyer, purchasing, contracts or negotiations type team.5+ years experience redlining and negotiating contracts with software and IT professional services vendorsThis position requires sound judgment, high ethical standards and a strong attention to detail.Must have the ability to work effectively and efficiently on multiple tasks in parallel, while meeting deadlines and maintaining high quality standards.Rudimentary knowledge and understanding of IT contracting methodologies is preferred.Must be comfortable with Microsoft Office products and able to learn and utilize new technology resources as required.We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Cyber Security Risk AnalystCollege Board - Risk ManagementLocation This is a fully remote role. Candidates who live near CB offices have the option of being fully remote or hybrid (Tuesday and Wednesday in office). Type: This is a full-time positionAbout the TeamThe Information Security Governance Risk and Compliance (ISGRC) team at the College Board checks and certifies the College Board's Information Security Programs. Our mission is to provide our stakeholders with meaningful insights that continuously improve the risk posture across the organization.ISGRC partners work with business leads to perform necessary security reviews of policies, systems, contracts, and vendors to better understand and manage risk. The team also manages security policies, security awareness training, and industry-recognized certifications (ISO 27001, SOC2 and PCI-DSS).About the OpportunityAs a Security Risk Analyst, you will have the critical role of being responsible for evaluating and managing exceptions to IT security policies, for managing the Organization's Risk and Control Issues Register (Risk Register), and for developing reports and metrics.Your strong technical communication and negotiation skills will help you build relationships and collaborate with diverse stakeholders and reduce risk to the organization and ensure compliance.Under the direction of management, you will manage the Risk Register and perform security policy exceptions to help the College Board understand its critical risks.In this role you will:Manage the Risk Register (20%)Leads the management of the issues and risks and quickly escalates any untimely completion of audit actions.Works independently to communicate risks and works with others to problem-solve risks to tolerance levels based on data and evidence.Maintains data quality of Risk Register and executes any required data clean-up exercises.Understands College Board work to be able to drive Risk or Control Owners to ensure consistent application of policies and standards.Raises awareness about Risk & Control Issues, Policy exceptions, and available risk reduction options.Fosters a culture of risk awareness and compliance within the technology department and across the organization.Manage Policy Exceptions (65%)Independently analyzes policy exception submissions and provide risk assessment reports for critical service lines, applications, and infrastructure hosted on-prem and in the cloud.Evaluates and manage exceptions to IT security policies.Manages materials for the Exception Review Board and present exception information to executive leadership and senior team members.Maintains an up-to-date knowledge and understanding of IT security policies and principles.Maintains a customer-focused attitude in all interactions with customers and colleagues.Manage Metrics and Reporting (15%)Provides weekly and monthly reporting for the Risk Register and policy exceptions.Produces trending metrics and escalate exceptions.Performs other duties as assigned.About You5-7 years of experience managing or supporting IT Security Risk and Control Risk Register and processing policy exceptions.Strong understanding of risk management techniques such as: risk identification, risk scoring, risk mitigation, and risk tracking.The proven ability to lead conversations balancing risk and multiple business needs that result in positive outcomes with multiple stakeholders.The capacity to assess risk information and make risk recommendations independently.Strong organization and prioritization skills and the proven ability to manage multiple tasks simultaneously, both independently and as a member of the team.7-10 years of experience in information security; governance, risk, and compliance; and/or information technology projects.Excellent verbal and written communication skills.Experience with governance, risk, and compliance tools (e.g., RSAM, RSA Archer) preferred.Experience with information security and privacy frameworks such as ISO 27001, COBIT, NIST-CSF, NIST 800-53, GDPR etc.Current Information Security Certification (e.g., CISSP, CRISC, CISM, CISA, or related security certification) preferred or the ability to attain one within 6 months of hire.Bachelor's degree in computer science, cybersecurity, engineering, IT management or four years equivalent IT and security industry experience.For remote positions, ability to travel 4 times a year to our Reston, VA office.Authorization to work for any employer in the USAAbout Our ProcessApplication review will begin immediately and will continue until the position is filledWhile the hiring process may vary, it generally includes: resume and application submission, recruiter phone screen, hiring manager interview, performance exercise and/or panel interview, and reference checks. This is an approximately 8-week processAbout Our Benefits and CompensationCollege Board offers a competitive benefits and compensation program that attracts top talent looking to make a difference in education. As a self-sustaining non-profit, we believe in compensating employees equitably in relation to each other, their qualifications, their impact, and the relevant market.The hiring range for a new employee in this position is $72000 to $120000. College Board differentiates salaries by location so where you live will narrow the portion of this range in which you can expect a salary.Your salary will be carefully determined based on your location, relevant experience, the external labor market, and the pay of College Board employees in similar roles. College Board strives to provide our best offer up front based on this criteria.Your salary is only one part of all that College Board offers, including but not limited to:A comprehensive package designed to support the well-being of employees and their families and promote education. Our robust benefits package includes health, dental, and vision insurance, generous paid time off, paid parental leave, fertility benefits, pet insurance, tuition assistance, retirement benefits, and moreRecognition of exceptional performance through annual bonuses, salary growth over time through market increases, and opportunities for merit raises and promotions based on increased scope of responsibilityA job that matters, a team that cares, and a place to learn, innovate and thriveYou can expect to have transparent conversations about benefits and compensation with our recruiters throughout your application process.#LI-Remote#LI-MD1