3 jobs found in walnut creek

NOTE - Position is listed in Walnut Creek, however position could be in other offices including Tampa, FL, and Lombard IL, or remote for the right candidate SUMMARY: This position holds accountability for the performance of Provider Contracting and Bill Processing for the Catastrophic Care Management Division. Responsible for timely and accurate delivery of provider cost projections and ad hoc negotiations at the individual contract level. Oversees and directs internal medical bill review process and directs the development of internal bill review procedures. Supervises and oversees medical contracting process. Manage the external relationships in medical bill review and provider contracting to ensure contracts and objectives are achieved with upmost efficiency and cost effectiveness. DUTIES AND RESPONSIBILITIES: Provide strategic and tactical leadership to ensure effective business processes and structure to support Bill Processing and Provider Contracting Manage ongoing provider contract performance evaluation through analysis, trending, and reporting of contract operational and financial effectiveness. Direct all Bill Review operations, ensuring that quality service is maintained and all Bill Review functions are operating efficiently across entire process from claim intake and all levels of cost adjustment, through approval and payment settlement. Reviews and adjusts medical records business processes to increase efficiency in the storing and managing of documents. Keeps current with legislation regarding PII and PHI data and ensures company processes meets all standards for storing and security of documents. Develops and implements Bill Review processing policies and procedures Evaluate vendor performance based on savings, customer service, network penetration, and other factors as indicated and organize appropriate actions, including PBM and PPO vendors. Serve as resource for department personnel and Paradigm Clinical Management staff (e.g. Director of Clinical Services, Clinical Services Coordinator, etc.) with injured worker-specific financial details for unique/challenging specific provider service, including direct negotiation, fee schedule and PPO access. Serve as advisor/resource to Bill Review staff regarding cost management alternatives to ensure optimal re-pricing methodologies on complex provider invoices. Serve as a liaison between providers and Paradigm staff to resolve inquiries and/or disputes regarding contract terms, Bill Review/bill payment, network participation, and other related issues. Coordinates with other departments to initiate process improvements and resolve business challenges. Lead state compliance initiatives and coordinate with Compliance team on pending changes in the regulatory environment. Develops and maintains department budgets for all departments assigned Manages growth within the department with appropriate use of overtime and addition of new staff as needed Designs and Implements various provider performance and feedback programs to promote continuous improvement of provider performance (e.g., provider performance evaluation & feedback, grievance/appeal resolution, etc.). IT security requirement and policies. Responsible for safeguarding Paradigm or Paradigm related IT passwords. Responsible for notifying Paradigm of any IT security incidents per Policy No. 16.0 Information Security Incident Management. QUALIFICATION REQUIREMENTS: To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education - Bachelors Degree in health care administration, business, finance or a related field from an accredited college or university or equivalent experience and education which demonstrates the ability to perform the functions of the position. Experience Minimum of ten years of experience with at least five years in a management position with demonstrated success in health care or related field including financial negotiations, contracting, medical bill review, and project management. Demonstrated understanding of wide variety of contracting methodologies. Must maintain understanding of changes in workers compensation market, regulatory and accrediting organizations. Language Skills - Excellent oral and written communication skills; able to make presentations to audiences of varying levels, size, nature and backgrounds. Reasoning Ability - Demonstrated ability to analyze difficult situations, problems and data and develop feasible and effective solutions. Demonstrated ability to implement and monitor project responsibilities. Any combination of education, experience and knowledge that demonstrate the ability to perform the functions of the position will be accepted. PI116350081

Description: SUMMARY: This position is responsible for ensuring that all interactions between administration, employees, customers, and outside services run as smoothly as possible, including office security. In general, this job entails two distinct responsibilities: customer service and correspondence. ESSENTIAL RESPONSIBILITIES include the following. Other work-related duties may be assigned. Effectively and efficiently manage the reception area of Paradigm interacting with employees, customers, and vendors while maintaining a high professional standard and professionalism. Answer incoming calls and direct calls correctly. Take and deliver messages as needed via email or directly call the individual. Welcome incoming customers and visitors upon their arrival. Notify internal person of their visitor. Check reception fax in-box at least twice daily and forward the fax to the addressed/appropriate individual. Forward any voicemails to the appropriate individual. Maintain cleanliness of lobby/front office area and executive conference room at all times. Packages delivered must be moved to mail room immediately after notification to recipient has been provided via email. No box is to be sitting on your desk or on the floor behind the desk. Process all incoming mail (USPS, overnight delivery, same day carrier, etc.), in accordance with the Mail Procedure document. Act as liaison for building management issues report issues to building management, when notified by an employee, using the online Angus system. Contact appropriate personnel to accept subpoenas. Approve Iron Mountain IT tape exchanges. Ensure connection of incoming calls from doctors to the appropriate CSC for conference calls. Create/update welcome signage on PowerPoint (upper left TV screen) upon request. Ensure UPS is picked up daily. Call UPS if packages are not picked up by 4:40 p.m. Print the Conference Call Schedule daily no later than 4:30 pm for next business day. Manage all aspects of weekly chair massage calendar. Monthly, ask each 8th floor department for office supply and paper requests. Order office supplies and paper (from Office Depot or Staples) based on colleagues requests and your current inventory of the copy rooms paper and office supplies. Keep all reception Desk Procedure documents current at all times. Responsible for complying with Paradigm IT security requirements and policies. Responsible for safeguarding Paradigm or Paradigm related IT passwords. Responsible for notifying Paradigm of any IT security incidents per Human Resources Policy No. 255 Information Security Incident Management. Act as manager of the eC Portal (Paradigms intranet): Update internal/external phone extension list upon notification of a change. Post and approve update on eC Portal at a minimum monthly. Update Org Charts using Visio upon notification of a change. Submit draft to HR Director and CFO obtaining approval from one or the other prior to posing a PDF version on eC Portal. This occurs monthly. Post Company Announcements on eC Portal within 24 hours of notification of a change. Post updated PDF version of the employee directory (Faces of Paradigm) monthly on eC Portal. Post Service Award notifications on eC Portal. Keep all Shared Documents updated on ecPortal within the past six months. Manage workplace posters for remote employees by posting current electronic posters on the eC Portal and update as changes in laws arise. Send notification to remote employees of location of posters. Manage Lawroom.com online training by enrolling, assigning and terminating training seats, and tracking (both contractors and employees) and printing certificates for each employees file. Act as an 8th floor safety committee member, in the case of an emergency. Continuously update and keep current the employee calendar. Have final draft ready to present by October 31. Assist in distribution of calendars in December annually. Assist in managing offsite storage: retention, protection, retrieval, transfer, destruction and disposal of records by: Performing an annual review of all records, drafting the communication for destruction, and making requests to destroy records once approved by Director, HR. Managing user access, training, and communications for use of the online storage management system (Iron Mountain) for department assistants. Shipping and Postage Manage outgoing mail, daily. This includes weighing, stamping, and preparing mail for pick-up or delivery to post office, when necessary. This responsibility must be completed by 2:30 p.m. daily. Be go to person to create USPS Priority Mail labels for packages. Print monthly postage report and send to Accounting Manager via email. Manage postage machine by ordering supplies, requesting and adding postage, and calling for service when needed. Manage user access, training, and communications for use of the online shipping system (UPS CampusShip). Order UPS and USPS mail shipping supplies as needed. Distribute incoming USPS employee mail to mail slots no later than 2 p.m. daily. PM19 .Requirements: QUALIFICATION REQUIREMENTS: To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. One year front desk reception experience. Two years customer service experience with one year of Human Resource/Benefits experience preferred. Knowledge of commonly-used concepts, practices, and procedures within the human resources, benefits, and reception fields. Intermediate skills in Microsoft Outlook, Word, Excel, PowerPoint, and Visio. Versatile, flexible, and willing to work in a consistently changing environment with enthusiasm. Acute attention to detail. Superior verbal and written communication skills. Proven ability to handle multiple projects while meeting deadlines. Strong interpersonal skills. Ability to understand and follow written and verbal instructions. Ability to deal effectively with a diversity of individuals at all organizational levels. Commitment to excellence and high standards. Ability to work independently and as a member of various teams and committees. Must be able to speak, read, write, and understand the primary language(s) used in the workplace: English. Ability to communicate professionally and effectively on the phone, in person, electronically, or through other means to individuals and groups. PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Environment Conditions - While performing the duties of this job, the employee does not work in wet or humid conditions (non-weather), work near moving mechanical parts, work in high, precarious places, endure outdoor weather conditions and/or endure extreme cold or heat (non-weather). Physical Activity - Interpret callers needs by asking specific questions. Coordinate multiple tasks simultaneously. Perform repetitive motion activities. Sit for long periods of time. Requires close vision and the ability to adjust eye focus often. Required to talk and hear. Required to reach with hands and arms. Requires minimal weight to be lifted (not more than 15 pounds) or force exerted. Required to communicate electronically. Occasionally required to be mobile. Noise Level - The noise level in the employee's work environment is usually quiet to moderate. PI116350093

US-CA-Walnut Creek Category Physicians Type Full-Time Regular Job Summary Amen Clinics are outpatient health care clinics that have been providing mental wellness strategies to patients of all ages since 1989. We offer patient-first experiences and customized solutions to an array of behavioral and psychiatric conditions. This is an exciting and unique professional opportunity. The Amen Clinics Psychiatrist provides clinical leadership to ensure treatment is evidence-based and outcome driven. Each Psychiatrist has the opportunity to use master's level clinical historians, psychological testing, neuropsychological screening tools, functional brain imaging, and emerging treatments such as TMS and neurofeedback. Amen Clinics offers mentoring on a variety of integrative methods that will expand your professional repertoire and our marketing and promotion efforts allow the multiple opportunities for writing and speaking engagements, if that appeals to you. Additionally, our clinics provide a healthy and aesthetically pleasing work environments. Essential Duties & Responsibilities Assist in the development, promotion and delivery of the approved Amen Clinics Method to brain health. Evaluate and treat patients and families who come to the clinics using nutraceutical, pharmacological, neurophysiological and behavioral approaches that enhance the Amen Clinics method to treating psychiatric and brain illnesses and enhancing overall brain health. Incorporate clinical history and SPECT scan findings during patient. Management of large patient case load: completing timely reports, maintaining charts, addressing patient concerns, and ensure the privacy and proper handling of patient information in accordance with State and Federal regulation. Expected to remain current with brain imaging, psychiatric, pharmaceutical and nutraceutical technologiesCommitment to using evidence based non-prescription interventions correlated with research findings by the Amen Clinics, Inc. Treatment of patients with: Attention deficit hyperactivity disorders Mood disorders Anxiety disorders Psychotic disorders Post-Traumatic Stress Disorder Traumatic brain injury Obesity Medical issues/hormone imbalances Addictions Alzheimer's Disease Memory and learning issues Cognitive impairment Autism spectrum disorders Qualifications, Knowledge, Skills & Abilities Board certification in Adult and/or Child and Adolescent Psychiatry preferred, but not required. Trained in addiction and substance abuse. Familiar with the strengths and weaknesses of medications (as well as other interventions). Understanding of and, ideally, experience using brain imaging in clinical practice. Experience working in a for profit setting- in which being efficient, developing referrals to practice, doing good clinical work and establishing positive therapeutic relationships. Experience dealing with medical issues including hormone imbalance and deficiencies as well as understanding the role they play in contributing to and/or complicating mental illness. Experience treating patients with interventions other than psychotropic medications including psychotherapy and evidence-based nutraceuticals. Time management, organization and computer skills and ability to work independently and within a team are critical. Empathy, emotional stability, ability to relate well to others, good communications skills and above all genuine care and regard for the patient are required. Willingness to learn to use brain imaging in clinical practice. We will train you on the applications of brain SPECT imaging in psychiatry and how to utilize this data in patient evaluations. Dedication to helping individuals, families and systems (such as schools, businesses, and treatment facilities) reach their full potential by creating and developing "brain healthy" strategies and practices. Interacts frequently with patients, clinic personnel and outside referral sources personnel by telephone, correspondence and personal contact. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Sitting for long period of time Frequent typing and viewing of computer screen Frequent use of hand and fingers with machines, such as computer, copier, fax machine, scanner and telephone Frequent hearing, listening and speaking by telephone and in person Occasionally required to stand, walk, reach with hands and arms, stoop or bend Work Environment: The work environment described here are representative of those that an employee encounters white performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work indoors in temperature-controlled environment The noise level is usually moderate with occasional outbursts from patients during treatment PI116151706