Job DescriptionCity/StateVirginia Beach, VAOverviewWork ShiftFirst (Days) (United States of America)Sentara Health is seeking to hire a qualified individual to join our team as an Intermediate Configuration Analyst - Remote! Position Status: Full-time, Day ShiftPosition Location: This position is 100% remote.Candidates must have a current residence in one of the following states or be willing to relocate:Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington State, West Virginia, Wisconsin, WyomingStandard Working Hours: 8:00 AM to 5:00 PM (ET).Minimum Requirements: 2+ years of operations and technical experience requiredAn Associate's level degree requiredPosition Overview:The Intermediate Configuration Analyst is an essential need for our team. We rely on this for role for complex analysis and system configurations.This role serves as a reliable bridge between claims, contracting, and internal & external customers.The Intermediate Configuration Analyst responsibilities include but are not limited to:Annual DMAS updatesMaintaining the pricing environments 3M, nThrive , NetworX and ModelerAnalyzing and maintaining the fee, rates, and reimbursement CSC and QNXTEnsuring all updates are properly identified, documented, and aligned with organizational policies and procedures.Maintaining the contracts CSC and QNXTAdditional support for BA's and Sr BA'sProviding guidance and support to various teams ranging from claims to contractingOverall, this role is essential in helping to maintain the integrity and stability of the Fee and Contracting TeamDiversity and Inclusion at Sentara Our vision is that everyone brings the strengths that come with diversity to work with them every day. When we are achieving our vision, we have team members that feel they belong and can be their authentic selves, and our workforce is reflective of the communities we serve.We are realizing this vision through our Diversity and Inclusion strategy, which has three pillars: A diverse and talented workforce, an inclusive and supportive workplace, and outreach and engagement with our community. We have made remarkable strides in these areas over the past several years and, as our world continues to evolve, we know our work is never done.Our strategies focus on bothstructural inclusion, which looks at our organizational structures, processes, and practices; as well asbehavioral inclusion, which evaluates our mindsets, skillsets, and relationships. Together, these strategies are moving our organization forward in an environment that fosters a culture of mutual respect and belonging for all.Please visit the link below to learn more about Sentara's commitment to diversity and inclusion:https://www.sentara.com/aboutus/mission-vision-and-values/diversity.aspxSentaraOverviewFor more than a decade, Modern Healthcare magazine has ranked Sentara Healthcare as one of the nation's top integrated healthcare systems. That's because we are dedicated to growth, innovation, and patient safety at more than 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals.Sentara BenefitsAs the third-largest employer in Virginia, Sentara Healthcare was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:Medical, Dental, and Vision InsurancePaid Annual Leave, Sick LeaveFlexible Spending AccountsRetirement funds with matching contributionSupplemental insurance policies, including legal, Life Insurance and AD&D among othersWork Perks program, including discounted movie and theme park tickets among other great dealsOpportunities for further advancement within our organizationSentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within avibrant, creative, and highly productive workplace. For information about our employee benefits, please visit:Benefits - Sentara (sentaracareers.com)Join our team!We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!Sentara Health offers employees comprehensive health & welfare and retirement benefits (401(k)/403(b) with employer match) designed with you and your family's well-being in mind. You have a variety of options for medical, dental and vision insurance, life insurance, disability, educational assistance, student loan repayment and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time, and paid parental leave. Colleagues have the opportunity to earn an annual discretionary bonus if the established system and employee eligibility criteria are met.Salary Range: $ 52,896.48 to $ 79,344.72 annually.Keywords: #ziprecruiter, #LI-DS1, #LinkedIn, 3M, nThrive , NetworX and Modeler, CSC, QNXT, configuration analyst, healthcare, remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington State, West Virginia, Wisconsin, WyomingJob SummaryThe Intermediate Configuration Analyst is responsible for performing complex analysis and system configuration. This individual will provide configuration support and project-related activities for internal and external customers, vendors, and consultants. The position requires demonstrated analytical skills. The work responsibilities are moderate level functional analysis to support management decisions, to detailed and technical system configuration.
2 Years of Operational and Technical experience required. In lieu of an Associates Degree will accept 4 years of Operational and Technical experience or Bachelors with 1 year of either operational or technical experience. In addition to the experience outlined above successful candidate must have basic planning and organizational skills with the ability to effectively prioritize multiple tasks and meet agreed upon deadlines.Qualifications:ALD - Associate's Level DegreeSkillsMicrosoft ExcelSentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
In support of our mission "to improve health every day," this is a tobacco-free environment.
Job DescriptionCity/StateDoral, FLOverviewWork ShiftFirst (Days) (United States of America)AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Wellness Health Coach in Miami, Florida. This is an onsite role and requires traveling to the following sites: Downtown Miami (Main location), North Miami and Palmetto Bay area.Scope of position:The Wellness Health Coach works under the direction of the Manager, Wellness and Health Promotion to engage members in healthy behaviors by providing one on one and group education support and wellness engagement. This position serves as an onsite wellness team liaison to ensure delivery of wellness department goals and to facilitate wellness engagement activities such as challenges, educational series, risk targeted programs, and other offerings that are part of the client's specific wellness program. The Wellness Health Coach's focus is on providing education and support related to modifiable lifestyle risks, facilitating behavior change, developing personalized wellness plan for coached members, and providing support for AvMed's overall wellness program offerings and goals.Essential Job Functions:Provides onsite one on one and telephonic coaching to members with a goal of health improvement through assessment and barrier identification, self-management education, appropriate referral wellness planning.Provides education to members on how to best access online self-management tools, the Wellness Program, and services available through the wellness program.Supports the coordination and delivery of worksite Health Events, such as biometric screenings, onsite flu shots and any other wellness sponsored actives.Coaches' members in understanding the Personal Health Assessment (PHA), Scorecard, Action Plan and results of biometric screening data; refer associates to follow-up for physician clinical evaluation as appropriate. Documents and reports on interactions, interventions and outcomes as directed.Provides education and behavior change tools on the following health areas: Nutrition, Physical Activity, Wellness Education and Referral, Disease Prevention / Health Risk Management, Women's Health Issues, Children's Health Issues, Men's Health Issues, Sleep, Stress Management, Weight Management, High Blood Pressure, High Cholesterol, Maternity / New Mothers, Smoking/Tobacco Cessation, Benefit Navigation, and other Wellness topics as necessary.Delivers health education seminars in person and by webinar as assigned and in response to client's aggregate reports, including, but not limited to associate PHAs, screenings and high-cost claims analysis for education and engagement in wellness resources; Conducts internal and external educational presentations.Collaborates with the Manager, Wellness and Health Promotion, Client Human Resource Department, and other Wellness team members, if applicable, to develop engagement strategies that support the overall health and wellness of members. Assesses client needs at various locations and makes recommendations to support employee wellness.Participates and leads client specific meetings as requested such as Health Coach and Wellness Champion calls for the sharing of best practices.Supports the Wellness Engagement Specialist with designing measurable field interventions to support ROI and VOI analyses.Performs additional duties and responsibilities as assigned by managementMinimum Requirements:Bachelor's degree in health and/or wellness related field is required0-2 years of experience in health coaching, motivational interviewing and/or health promotionExperience in nutrition is highly desiredMust have a valid Florida Driver's license or state of Florida issued IDCertification as a health coach highly desiredTobacco Cessation certification highly desiredAn equivalent combination of education and experience may be consideredPreferred Requirements:Effective motivational interviewing skills Bilingual English/Creole and or English/ Spanish Ability to effectively manage multiple projects without additional resources or supportAbility to develop presentations and present to large groups and stakeholdersAbility to think creativelyAbility to work independentlyExcellent communication skills - oral and writtenAbility to work effectively and efficiently with othersAbility to work in multiple fast-paced environments Our Benefits:As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:Medical, Dental, and Vision InsurancePaid Annual Leave, Sick LeaveFlexible Spending AccountsRetirement funds with matching contributionSupplemental insurance policies, including legal, Life Insurance and AD&D among othersWork Perks program including discounted movie and theme park tickets among other great dealsOpportunities for further advancement within our organizationSentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!Note: Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.Keywords: Talroo-health Plan, #ZipRecruiter, Motivational Interviewing, Coaching, Wellness EducationJob SummaryResponsible for planning, coordinating and implementing a variety of wellness activities for employer groups, at-risk populations, and the community at large to evaluate the health status, maintain outcomes quality and meet specific identified needs which promote wellness and improve health. Many of the tasks associated with the position involve data input, data management and data reporting. This is support position for the Community Health and Prevention team.
Experience - 5 years required in lieu of bachelors degree.Qualifications:ALD - Associate's Level Degree (Required), BLD - Bachelor's Level DegreeProject ManagementSkillsMicrosoft Access, Microsoft ExcelSentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
In support of our mission "to improve health every day," this is a tobacco-free environment.
Job DescriptionCity/StateTallahassee, FLOverviewWork ShiftFirst (Days) (United States of America)AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Remote Principal Fraud & Abuse Investigator.
The Remote Principal Fraud & Abuse Investigator is responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products in Sentara Health Plans lines of business. Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital-based coding in routine desk audits as well as occasional on-site audits Contribute to the review of reimbursement systems relating to health insurance claims processing and ensures adherence to health plan policies and procedures for its various product offerings. Specific progression of responsibility is a follows dependent upon education, certifications, and experience. Assist manager in development and conducting division wide Fraud, Waste and Abuse related training. Develops and updates department policies and procedures and trains staff as needed. Develops and prepares departmental reporting for internal and external use. Assist manager in implantation and compliance with of state and federal program integrity activities and reporting requirements. Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. Assists in training and provides guidance to staff.Remote opportunities available in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming
Requirements:
Bachelor's Degree in related discipline required.
8-10 years of related investigative experience OR 5-7 years of related healthcare investigative experience AND CFE OR AHFI
Certified Professional Coder required (or achieved within 12 months of hire date) AND Accredited Health Care Fraud Investigator (AHFI) required (or achieved within 24 months of date of hire)
(Note: Federal Agents who have successfully completed the Federal Bureau of Investigation Training Program (FBITP) - Criminal Investigator Training Program (CITP) would be considered equivalent to the AHFI)
5 years of Coding, Healthcare, Internal/External Audits & Regulatory Compliance.Preferred Qualifications:
Certified Fraud Specialist (CFS),
Certified Professional Coder (CPC)
Certified Forensic Interviewer (CFI)
Certified in Healthcare Compliance (CHC)hen Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products in Sentara Health Plans lines of business. Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital-based coding in routine desk audits as well as occasional on-site audits Contribute to the review of reimbursement systems relating to health insurance claims processing and ensures adherence to health plan policies and procedures for its various product offerings. Specific progression of responsibility is a follows dependent upon education, certifications, and experience. Assist manager in development and conducting division wide Fraud, Waste and Abuse related training. Develops and updates department policies and procedures and trains staff as needed. Develops and prepares departmental reporting for internal and external use. Assist manager in implantation and compliance with of state and federal program integrity activities and reporting requirements. Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. Assists in training and provides guidance to staff.Our Benefits:
As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:
Medical, Dental, and Vision Insurance
Paid Annual Leave, Sick Leave
Flexible Spending Accounts
Retirement funds with matching contribution
Supplemental insurance policies, including legal, Life Insurance and AD&D among others
Work Perks program including discounted movie and theme park tickets among other great deals
Opportunities for further advancement within our organization
Sentara employees strive to make our communities healthier places to live. We are setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)
Sentara Health offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.
For applicants within Washington and Maryland State, the following hiring range will be applied: $76,003.20 annually to $ 104,919.36 annually
Keywords: Talroo-health Plan, #ZipRecruiter, Coding, Internal/External Auditing
Job SummaryResponsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products in Sentara Health Plans lines of business. Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits Contribute to the review of reimbursement systems relating to health insurance claims processing and ensures adherence to health plan policies and procedures for its various product offerings. Specific progression of responsibility is a follows dependent upon education, certifications, and experience. Assist manager in development and conducting division wide Fraud, Waste and Abuse related training. Develops and updates department policies and procedures and trains staff as needed. Develops and prepares departmental reporting for internal and external use. Assist manager in implantation and compliance with of state and federal program integrity activities and reporting requirements. Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. Assists in training and provides guidance to staff.
Bachelor's Degree in related discipline required.
8-10 years of related investigative experience OR 5-7 years of related healthcare investigative experience AND CFE OR AHFI
Certified Professional Coder required (or achieved within 12 months of hire date) AND Accredited Health Care Fraud Investigator (AHFI) required (or achieved within 24 months of date of hire)
(Note: Federal Agents who have successfully completed the Federal Bureau of Investigation Training Program (FBITP) - Criminal Investigator Training Program (CITP) would be considered equivalent to the AHFI)
Preferred Qualifications:
1.Certified Fraud Specialist (CFS),
2.Certified Professional Coder (CPC)
3.Certified Forensic Interviewer (CFI), or
4.Certified in Healthcare Compliance (CHC)Qualifications:BLD - Bachelor's Level Degree (Required)Certified Professional Coder (CPC) - Certification - American Academy of Professional Coders (AAPC)Coding, Healthcare, Internal/External Audit, Regulatory/ComplianceSkillsCommunication, Complex Problem Solving, Critical Thinking, Microsoft Access, Microsoft Excel, Microsoft Word, Time Management, WritingSentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
In support of our mission "to improve health every day," this is a tobacco-free environment.
