The specialist is responsible for resolving outstanding insurance accounts receivable through proactive follow-up, denial management, and appeals. They will analyze denial trends and utilize various tools to improve revenue cycle performance for assigned client accounts.
The Clinical Consulting Manager will perform clinical documentation reviews, ensure regulatory compliance, and provide operational support to home health and hospice clients. They will also analyze trends, provide process improvement recommendations, and support clients through medical review appeals.
Manage and resolve complex application incidents and service requests while maintaining high-quality documentation in the ticketing system. Partner with clients to ensure optimal performance of Netsmart solutions through effective communication and analytical troubleshooting.
Review and evaluate electronic medical records for emergency department admissions to ensure medical necessity using clinical criteria. Participate in telephonic discussions with physicians and transmit clinical review information to insurance companies for authorization.
The IT Systems Administrator is responsible for the provisioning, configuration, and maintenance of enterprise infrastructure systems to ensure reliable business operations. This role involves administering server, network, and storage environments while collaborating with teams to troubleshoot issues and implement system enhancements.
Review OASIS documentation and ICD-10 coding to ensure accuracy, compliance, and quality in patient charts. Document recommended changes and their impact on reimbursement while meeting quality metrics and deadlines.
Identify and close strategic revenue cycle opportunities with large health systems and provider organizations. Act as a trusted advisor to C-suite executives to improve financial performance and operational efficiency through subscription-based services.
