Location: Oklahoma City, OK
Company: Centene
records and documents supporting claims for providers, suppliers, and pharmacies to include but not limited to physicians, inpatient, outpatient, ancillary, behavioral health care, laboratory, etc. Provides investigative support to the Special Investigations Unit (SIU) related to coding and billing issues and identifies potential overpayments and suspected health care fraud and abuse.
Position requires the associate to verify authorization for services and written documentation of services provided against claim information, ensure the appropriateness and accuracy of diagnosis and procedure codes supporting such claims, coordinate medical necessity and appropriate level of care determinations
with Medical Directors, and validate services against CMS and State-specific coverage, limitations and exclusion guidelines. Coordinate with internal and external resources in determining the appropriateness of codes found in administrative, medical, claim and financial records, develop reports of findings and recommendations, communicate complex results of audit findings in meetings and/or judicial hearings, and assist SIU investigators during interviews, discussions and negotiations with providers, suppliers, and pharmacies.
Perform retrospective and prepayment reviews of medical records to identify potential fraud, waste, and abuse and inappropriate billing practices. Investigate,
analyze, and identify provider billing patterns to determine payment based on medical records, claim history, billing codes, regulatory and state guidelines, and policies.
Prepare summary of findings and recommend next steps for providers. Identify preventative measures and recommend changes to internal policies and procedures and/or provider practices to prevent future fraudulent and erroneous practices. Collaborate with investigators to identify abuse and fraud by utilizing clinical and coding expertise to analyze patterns in billing activities. Education/Experience: Master s Degree and 2 years of relevant experience required. 2+ years clinical experience with independent license required; 2 years of fraud, waste, and abuse experience required; experience in provider education and managed care organization preferred; coding certification preferred.
License/Certification: Behavioral health license - LMHC, LCSW, LMFT, LPC, LMHP, LIMHPOur Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, interaction, interactionual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Associated topics: adult, behavioral, behavioral healthcare, clinical, clinician, field, mental, msw, outpatient, youth
tuition reimbursement, annual uniform allowance, holiday pay etc. Days: Thursday, Friday, and Saturday Hours: 7:00 p. m. to 7:00 a. m. (NIGHTS) Position: To provide compatibility testing and consultation services for resolution of complex serological problems.
Qualifications: Bachelor of Science degree with completion of a Medical Technology (MT)/Medical Laboratory Science (MLS) training program ASCP registration preferred Ability to resolve complex serological problems independently Provide clear and concise consultation to other medical technologists and physicians Excellent oral and written communication skills Team player Special Physical Requirements: Must have full sight Hearing
impairment requiring a hearing aid(s) is acceptable Must be fully ambulatory Moderate lifting required Special Licensing/Certifications: Completion of accredited Medical Technology/Medical Laboratory Science training program Primary Responsibilities: Perform quality control, calibration, maintenance and verification procedures for laboratory equipment Receive hospital orders Work with lab couriers or Storage and Distribution on the coordination of specimen pick-ups and product delivery Review patients medical and transfusion history and correlate with laboratory investigation Perform ABO, Rh, antibody detection and compatibility testing procedures for transfusion service clients Perform antibody
identification for transfusion service clients and member hospital clients Fill orders for antigen negative requests Perform RBC crossmatch and procedures selecting antigen negative units as needed Perform antibody titration procedures Perform complex antibody identification procedures using different testing platforms and reagents Prepare consultation reports Takes call as needed for laboratory coverage Clean and maintain work areas Click the link below to learn fun facts about working for Our Blood Institute!
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centered on transforming the road to recovery for everyone and helping patients get their power back. It's patient-centered care that provides a sustainable way of feeling better, moving better, breathing better, and living better. POSITION SUMMARY: The Physical Therapist will primarily provide outpatient rehabilitation services in an in-home setting for the older adult population.
The in-home setting could be a patient's private residence or in a patient's room in an independent living facility. Powerback Rehabilitation To You allows the Physical Therapist to evaluate and treat in the most functional environment which is the patient's home. The Physical Therapist backsses the need for,
develops, and delivers physical therapy programs to facilitate rehabilitation. The Physical Therapist identifies the need for and makes referral(s) to other disciplines to address the comprehensive needs of patients.
They implement individualized therapy programs designed to restore, reinforce, and enhance performance. In addition, the Physical Therapist instructs, educates and trains patients and caregivers in those skills and functions essential for promoting independence and productivity, in order to diminish or correct pathology. They direct activities to promote and maintain health. This position provides a flexible schedule and work environment in various settings. RESPONSIBILITIES/ACCOUNTABILITIES:1.
As necessary or applicable, supervision of Physical Therapy Assistants, temporary licensees, students and support personnel in accordance with state licensure requirements and professional standards.2.
Responsible for adherence to department and patient treatment schedule, timely clinical and billing documentation requirements as well as work related meetings.3. Attends and contributes to patient care, staffing conferences and other related meetings.4. Makes referrals to other disciplines and agencies in order to address the comprehensive needs of the patient.5. Consults with other members of the rehabilitation team to select the most appropriate therapeutic regimen consistent with the needs and capabilities of each patient.6.
Adapts program and/or plan of care according to the needs of the individual patient.7. Promotes a safe environment and enforces the elimination of fire and safety hazards.8. Orders supplies and equipment as necessary.9. Cleans, maintains, identifies, and reports the need for repair of equipment as necessary.10. Puts patient service first: ensures that patients and families receive the highest quality of service in a caring and compassionate atmosphere which recognizes the individuals' needs and rights.11.
Screens, examines and evaluates patients, including history, systems review, and application of appropriate tests and measures, synthesis information and interprets examination findings in order to establish a diagnosis, identify impairments, determine the predicted level of improvement and the time required to achieve it, identify precautions/contraindications and design and plan of care. Develops appropriate treatment goals and methods in collaboration with the patient and caregivers, implements the physical therapy treatment plan, and completes all related documentation and record keeping regarding these services.
Services include but are not limited to application of therapeutic techniques in areas such as: Therapeutic exercise including aerobic capacity conditioning, balance coordination, agility training, body mechanics and postural stabilization, flexibility exercises, gait and locomotion training, neuromotor development training, relaxation, strength, power, and endurance training Functional training Manual therapy Airway clearance techniques Integumentary repair and protection Use of electrotherapeutic, physical agent and mechanical modalities Health and Wellness Education on Chronic Disease Management Falls backssment and Interventions to reduce fall risk Case Management in the home and community12.
Designs, fabricates, fits and/or applies adaptive devices, and trains patients in the use of adaptive devices included orthotics and prosthetics.13. Selects appropriate activities suited to the individual's physical and mental capacity, intelligence level and interest.14. Instructs patient in the skills and techniques required for participation in mobility activities and evaluates patient progress, attitudes, and behavior as related to rehabilitative potential.15.
Performs routine reexamination as needed/required to modify/progress plan of treatment.16. Incorporates health and wellness programming into treatment plans for patients.17. Performs home and community mobility backssments and provides recommendations for safe mobility in the home and community space.18. Performs other related duties as required. SHAREPTHVPando Logic. Keywords: Physical Therapist (PT), Location: Claremore, OK - 74018 , PL: 574659266For more details: jobs-search. org/physical-therapist_claremore-c443958/physical-therapist-in-home-outpatient-therapy-claremore-ok-claremore_i1967105190
