$27.59–$56.63/hr
Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska
Molina Healthcare · Tulsa, OK
Job description
JOB DESCRIPTION This position will offer remote work flexibility, but the selected candidate must reside in Nebraska. Opportunity for a Registered Nurse who has a US license in good standing to join our Medicaid Team as a Clinical Auditor. The person filling this role will be an instrumental part of the team work to align the Medicaid Team compliance guidelines with those followed by our corporate teams. Knowledge and experience working with NCQA standards is vital to success in this role. The preferred candidate will have 3 – 5 years of experience in a MCO and at least 2 years of clinical auditing and/or review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill sets we are seeking. Hours are Monday – Friday, 8AM – 5PM in your time zone. Job Summary Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Performs audits in care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met. • Assesses clinical staff regarding appropriate clinical decision-making. • Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership. • Ensures auditing approaches follow a Molina standard in approach and tool use. • Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications. • Adheres to departmental standards, policies and protocols. • Maintains detailed records of auditing results. • Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results. • Meets minimum production standards related to clinical auditing. • May conduct staff trainings as needed. • Communicates with quality and/or healthcare services leadership regarding issues identified and works collaboratively to subsequently resolve/correct. Required Qualifications • At least 2 years health care experience, with at least 1 year experience in care management, and/or managed care, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and restricted in state of practice. • Strong attention to detail and organizational skills. • Strong analytical and problem-solving skills. • Ability to work in a cross-functional, professional environment. • Ability to work on a team and independently. • Excellent verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $27.59 - $56.63 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
More jobs in Tulsa, OK
Conductor de entregas – no requiere experiencia
DoorDash · Tulsa, OK
Por qué entregar con DoorDash?.DoorDash es el líder número uno de la categoría en entregas de comida, retiro de comida y entregas de tiendas de conveniencia en EE.Como Dasher, tendrás múltiples oportunidades de ganancias y podrás trabajar cuando te convenga.Ser repartidor con DoorDash te da l
$85k–$110k/yr
$85 - $110K /Yr! Hiring CDL-A Truck Drivers - Quick Apply!
Hiring Drivers Now · Tulsa, OK
Now Hiring CDL-A Truck Drivers! Apply today and within 24 hours you'll receive multiple job offers. Earn $.60 - $.80+ CPM and up per year based on position. Simply select the driving job that offers you what is most important. Higher pay, increased benefits or more home-time: You choose. Avg. Company Driver Job Offers Salary: $85,000-$110,000+ Avg. Owner Operator Job Offers Salary: $200,000-$325,000+ Apply now to receive your job offers!
Service Center Associate
Eteam · Tulsa, OK
Job Title: Service Center Associate Location: Seven Hills, OH REMOTE Duration: 9 months Duties: CANDIDATES WILL WORK REMOTE, PREFERRED CENTRAL OR EASTERN TIME ZONE. Training Schedule Starting Monday August 17th, 2026 Monday through Friday 8am-5pm EASTERN 2-week training After Training Hours of Operation: 10am-8pm EST, 7 days a week Rep will work 5 days (1 day will be a weekend day) 8 hour shifts including a 30 minute lunch. Possible Schedules: 10:00am-6:30pm EST 10:30am-7:00pm EST 11:00am-7:30pm EST 11:30am-8:00pm EST Weekends are required - has one weekend day off, one day off during the week Equipment will be provided (desktop, monitors, keyboard, mouse, headset) but they may need to use a personal device to attend at the start of training. This will depend on arrival of equipment. Must have broadband internet service. Must be able to have client computer, telephone and VPN devices plug directly into the router within their home. Must not work over WIFI connection in their home regardless of upload or download speed. Pre Screening Questions Have you ever worked in a call center before? What experience do you have working from home? How comfortable are you using the elements of Microsoft office and using multiple systems at once? If yes, can you give an example from your past experience? What do you like/dislike about your current work environment? Are you able to work a weekend day Have you worked with client before? Provide name of manager, duration, reason behind leaving? QUALIFICATIONS Education & Licensing High school diploma or GED required. Experience One (1) year of clerical or customer service experience or equivalent combination of education and experience preferred. Skills & Knowledge Excellent oral and written communication PC literate, including Microsoft Office products Good customer service skills Strong organizational skills Good interpersonal skills Ability to work in a team environment Ability to meet or exceed Performance Competencies PRIMARY PURPOSE: To expedite the Customer Service claims application process; to ensure correct case assignment; and to act as a customer liaison in assisting the customer with the correct contact person to resolve problems and/or questions. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Assigns new claims to the appropriate claims handler. Enters verbal and written application information that meets both the internal and external customers' requirements accurately into the claims management system. Contacts the customer by telephone, written correspondence and/or the claims system regarding documentation required to process a claim, required time frames and claim status. Communicates clearly and professionally with the customer by telephone and/or written correspondence regarding all aspects of claims process. Participates in and maintains a quality service culture within the Customer Service Team. Attendance during scheduled work hours is required. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s).
Patient Service Representative
Saint Francis Health System · Tulsa, OK
Current Saint Francis Employees - Please click HERE ( to login and apply. Full Time Days Job Summary: Performs reception, registration and billing functions in the front officeof the Medical Practice to facilitate the effective delivery of patient care. Minimum Education: High School Diploma or GED. Licensure, Registration and/or Certification: None. Work Experience: One (1) year experience. Knowledge, Skills and Abilities: Demonstrated PC skills. Effective organization of multi-task role. Understanding of healthcare delivery and billing processes in the medical office. Ability to accurately record and interpret data. Effective interpersonal, written and oral communication skills. Ability to organize and prioritize work in an effective and efficient manner. Essential Functions and Responsibilities: Maintains exemplary patient satisfaction and participates as an engaged team member. Greets and directs patients and visitors according to established office protocols. Informs patients of delays in care. Communicates schedule changes to physicians, clinical assistants and other staff as appropriate. Maintains and corrects environment for cleanliness and safety. Schedules appointments, registers demographic and billing information, determines eligibility to accommodate patient's care in the medical office. Successfully uses the EMR and other computer applications to accomplish tasks according to policies and procedures. Maintains medical records including preparation of charts, filing of correspondence and test results. Prepares encounter forms and other supporting billing documentation. Maintains and distributes provider schedules including application of templates, hold times, etc. Determines and collects co-pays and deductibles from patients. Requests payments of self pay balances according to policies. Responsible for preparation of cash receipts, bank deposits and balancing of cash drawer on a daily basis. Converts provider written description of diagnosis to appropriate ICD-9 code. Posts charges and payments to patient accounts. Reviews and corrects rejected or denied claims. Reviews and assists in collections of past due accounts. Prepares phone notes for communication to the provider from patients, pharmacists, and other healthcare sources. Makes calls to patients to remind them of pending appointments or communication from provider. Distributes mail and other communication to patients, providers and staff. Determines eligibility and obtains authorization for services. Schedules tests and appointments for referred services. Tracks referrals made for specified services. Participates in quality initiatives and safety functions. Assists in identifying and ordering needed supplies. Remains informed and compliant with current Health System, Warren Clinic, HIPAA and OSHA policies and procedures. Decision Making: Independent judgment in planning the sequence of operations and making decisions in a complex technical or professional field. Working Relationships: Works directly with patients and/or customers. Works with internal / external customers. Works with other healthcare professionals and staff. Works frequently with individuals at director level or above. Special Job Dimensions: None. Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties. Hospitalist - Yale Campus Location: Tulsa, Oklahoma 74136 EOE Protected Veterans/Disability