The Medical Director provides clinical leadership for the Disability Evaluation Services (DES) Program and is responsible for supervising the physician advisors and quality assurance consultants as well as ensuring compliance for contracted network consultative examination providers. The director leads internal Clinical Consultation Committee for the handling and decision making of contested cases.

The National Sr. Director, Program Development, Health Science, Resuscitation is responsible for developing and leading the Resuscitation Science function. They will work with Emergency Cardiovascular Care (ECC) volunteers to oversee the development of the ECC guidelines and science review for ECC products.

The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines. Reviews claims, requests additional information, and initiates claim investigations. Maintains production and quality standards and participates in training.

Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities.

This role is a unique opportunity for an experienced medical coder with robust risk adjustment auditing experience. You will review medical records, prepare audit results reports, and provide coding insights to Fathom engineering and client success teams to accelerate product development. You should have a current AAPC CRC certification or AHIMA RAC microcredential.

The Benefit Configuration Analyst will implement new client benefit setup and hierarchy based on the specific needs of the customer. Benefit setup based on plan design changes of existing customers. Configures all aspects of benefit plan per health plan utilizing the Financial Risk Matrix for major commercial, Medicare Advantage and Medicaid Health Plans.

Avalere is seeking a Consultant I to join our Healthcare Policy practice. This position offers an exciting opportunity to contribute to shaping and analyzing healthcare policy and delivering actionable insights that drive our clients’ business and advocacy priorities. We are seeking a policy professional who loves to generate creative solutions to complex problems.

Primarily responsible for converting inquiries into scheduled admissions at Acadia facilities, and maintaining communications between the organization, referral source, patient and family. Support multiple facilities’ admissions functions within a given region to promptly assist clients and their family’s seeking treatment.

This is a remote Admissions Services Specialist position supporting Acute Behavioral Health Facilities. The role involves verifying benefits, monitoring and processing patient referrals, responding to inquiries, and supporting admissions departments throughout the country, with a strong emphasis on admissions & intake functions.

This position is responsible for timely, accurate and comprehensive review of diagnoses and procedure services, verifying charges and assigns valid ICD-10 and CPT codes, as appropriate, to ensure optimal reimbursement and regulatory compliance. Responsibilities include analyzing and coding complex cases and identifying trends/ problems in medical documentation.