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Position Details
Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 892 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.
Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.
Active - Benefit Eligible and Accrues Time Off
Work Hours per Biweekly Pay Period: 80.00
Shift: Flexible Hours and/or Flexible Schedule
Location: 210 South Florida Avenue Lakeland, FL
Pay Rate: Min $19.37 Mid $24.22
Position Summary
Under the direction of the Coding and Clinical Documentation Improvement Manager, reviews clinical documentation and diagnostic results, as appropriate, to extract data and apply appropriate ICD-10-CM, CPT, and/or HCPCS codes and modifiers to outpatient encounters for reimbursement and statistical purposes. Communicates with physicians, Physician Advisor or other hospital team members as needed to obtain optimal documentation to meet coding and compliance standards. Abstracts clinical and demographic information in ICD-10 CM, CPT, and HCPCS codes and modifiers into the computerized patient abstract. Participates in ongoing continued education to assure knowledge and compliance with annual changes.
Position Responsibilities
People At The Heart Of All That We Do
- Fosters an inclusive and engaged environment through teamwork and collaboration.
- Ensures patients and families have the best possible experiences across the continuum of care.
- Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
Safety And Performance Improvement
- Behaves in a mindful manner focused on self, patient, visitor, and team safety.
- Demonstrates accountability and commitment to quality work.
- Participates actively in process improvement and adoption of standard work.
Stewardship
- Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
- Knows and adheres to organizational and department policies and procedures.
Standard Work Duties: Coder II - Outpatient
- Assigns and sequences diagnostic and procedural codes using appropriate classification systems utilizing official coding guidelines. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding
- Abstracts and enters coded data as well as correct surgeon, anesthesiologist and procedure date. Assures appropriate information such as pathology and operative reports are present in the medical record prior to final coding for coding accuracy and appropriate APC assignment.
- Maintains appropriate level of coding and abstracting productivity and quality for outpatient diagnostic, Emergency Department, Family Health Center, ambulatory surgeries, observations, and other recurring services as per established minimum per hour requirement.
- Demonstrates competence in coding and abstracting requirements by maintaining less than 5% error rate for all ICD-10-CM and/or PCS, CPT, and HCPCS codes and modifiers.
- Continuously reviews changes in coding rules and regulations including in Coding Clinic, CPT Assistant, CMS, and other payer guidelines.
- Prioritizes coding functions as directed by the Manager, and organizes job functions and work assignments to efficiently complete tasks within the established time frames.
- Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.
- Works collaboratively with the Discharge Not Final Billed (DNFB) clerks to prioritize workload daily.
- Reviews appropriate outpatient work queues daily to address coding reviews, edits and corrections.
- Reviews appropriate outpatient work queues daily to address coding reviews, edits and corrections.
Competencies & Skills
Essential:
- Computer Experience, especially with computerized encoder products and computer-assisted coding applications.
- Requires critical thinking skills, organizational skills, written and verbal communication skills, decisive judgment, and the ability to work with minimal supervision.
- Knowledge of anatomy and physiology, pharmacology, and medical terminology.
Qualifications & Experience
Essential:
- High School or Equivalent
Nonessential:
- Associate Degree
Essential:
- High School diploma with Associate Degree from accredited HIM program or certificate in coding from an accredited college.
Other information:
Certifications Essential: CCS
Certifications Preferred: Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA).
Experience Essential:
2-5 years acute care hospital outpatient coding experience within the past five years, or 5-7 year's experience in a multi-disciplinary clinic including surgeries and/or Emergency Department coding.
The pay range for this role is $4
Position Summary:
Provides leadership to the organization relative to Clinical Regulatory Compliance program which assures the implementation and oversight of clinical requirements developed by Center for Medicare and Medicaid (CMS), the Department of Health (DOH), and The Joint Commission (TJC). The primary purpose of the Clinical Regulatory Compliance Program is to ensure that the hospital's policies and practices comply with the requirements of external organizations that regulate or accredit the hospital, and to monitor the organization's compliance with its own policies. This function is distinct from the compliance program that operates under the authority of the Compliance Officer. Provide leadership to include the assessment, development and evaluations of programs related to staff education for all staff throughout the facility.
Education, License & Cert:
Bachelor’s degree in Nursing. A Master’s degree, in Education or Nursing, is preferred. Licensed Registered Nurse in the appropriate state.
Experience:
Minimum of five years acute hospital experience. Prior experience in leadership/management desired. Demonstrated effective communications, critical thinking/problem solving skills required.
Essential Functions:
1. Assumes leadership responsibilities for the program including:
a. Goal setting, developing monitoring tools, status reporting
b. Organizing department
c. Budget planning and management
d. Monitoring the work of others outside the department
e. Utilizes data for decision making and strategic planning
2. Prepares reports to regulatory agencies on a timely basis
a. Submits required reports to external agencies
b. Develops corrective action plans as required
c. Monitors and reports on the implementation of corrective action plans
3. Responsible for assuring that the organization complies with new clinical requirements announced by the Joint Commission, CMS, or the DOH
a. Ensure that the hospital's leadership is aware of new requirements
b. Ensure that plans are developed and implemented to meet these requirements
c. Ensure that newly implemented processes are integrated into ongoing management and operational activities
d. Ensures that effectiveness of regulatory action plans or new processes are monitored to evaluate compliance
e. Keeps hospital leaders and administration (including the Board) informed of regulatory findings and action plan progress via formal and/or informal reports on a regular basis
4. Demonstrates ability to be a person of influence
a. Builds trust
b. Provides leadership for implementing changes/performance improvement efforts, even though operational area may not directly report to this position
c. Creates a work environment that enhances employee, patient and physician satisfaction
d. Sets performance expectations/goals and maintains high standards of performance
e. Collaborates with organizational line management to assure full compliance
5. Provides a consulting/facilitation role in the organization for performance improvement activities and processes.
a. Facilitates committees, teams and workgroups
b. Supports medical staff initiatives
c. Assists in project development and management
d. Assists in operationalizing electronic health record changes (i.e. orders, documentation fields/screens) that are consistent with clinical regulations and hospital policies.
Other Duties:
1. It is understood that this description is not intended to be all‐inclusive. Other duties may be assigned as necessary.
2. Takes Administrator An Call assignment
3. Travel is required
Vice President of Operations
Our client located in San Antonio, Texas is adding a Vice President of Operations to their team. This is a direct hire opportunity.
Company Profile:
A large, mission-driven healthcare services organization operating across multiple locations in Texas. The organization delivers essential services through a regulated care model and employs a sizable, diverse workforce. The culture is values-based, people-focused, and committed to operational excellence, compliance, and leadership development
Vice President of Operations Role:
The Vice President of Operations oversees all Home Health Agency services and ensures operational excellence, regulatory compliance, and client satisfaction. This role functions under the direction of the COO and supervises Regional Directors, Trainers, and departmental leaders.
Operational Leadership
Oversee Regional Directors and Trainers across all locations.
Monitor office operations to ensure compliance with federal, state, and program regulations.
Serve as a resource for administrators on operational questions and issues.
Identify operational gaps and implement corrective action plans.
Regulatory & Compliance Oversight
Ensure adherence to licensure requirements and state/federal regulations.
Collaborate with QA/PI (Quality Assurance & Performance Improvement) to implement and monitor Plans of Correction (POCs).
Maintain confidentiality and compliance with organizational policies.
Clinical & Client Care Oversight
Monitor client care trends and address issues across all sites.
Plan and deliver staff education on client care, licensure, and program rules.
Ensure compliance with all contracts and program-specific regulations.
Staffing & Workforce Strategy
Monitor staffing trends and work with Recruiting to address underutilization or high vacancy areas.
Identify training needs and coordinate with the Training Department to ensure staff competency.
Department Oversight
Oversee Customer Service Department to ensure accurate and timely authorizations.
Manage Adaptive Aides/Minor Home Modifications (AA/MHM) Department to maintain compliance and timely documentation.
Strategic & Cross-Functional Collaboration
Collaborate with HR and integration teams during ongoing system modernization.
Support implementation of operational best practices.
Perform additional duties as assigned by the COO.
Vice President of Operations Background Profile:
Minimum 2 years as an executive in a mid-level healthcare leadership role
Experience in multi-site agency or facility management
Experience in:
Home Health (preferred)
Home Care (preferred)
Open to Hospice, Hospital, or Skilled Nursing Facility experience
Knowledge of healthcare regulatory compliance
Experience working with QA/PI programs
Proficiency in MS Word and Excel; ability to learn agency-specific software
Experience managing department-level leaders
Experience with Managed Care contracts
Hands-on operational leader
Regulatory-savvy and compliance-focused
Experienced in healthcare operations during transitions or system modernization
Able to manage multiple departments effectively
Ability to travel 3 weeks out of the month- weekends at home
Features and Benefits of Client:
100% paid employee and family Health Benefits
4 weeks PTO, Sick Days, and Holidays
Free Parking
Casual Dress
Corporate Break Room
Director of Hospice Inpatient Unit
If you are an experienced, Area Director of Operations, Regional Administrator, Regional Director, Director of Operations, or Executive Director with Hospice Inpatient Unit experience, then you need to read on…
Director of Hospice Inpatient Unit Opportunity Description
Our client is a well-established Hospice organization. They have a current opening for a Director of Hospice Inpatient Unit to oversee their facility in the Greater Virginia Beach, VA area. Registered Nurse is required. Hospice inpatient unit experience highly preferred. Relocation candidates will be considered.
Director of Hospice Inpatient Unit Job Requirements
- Registered Nurse with Virginia State license.
- BSN highly preferred.
- A minimum of five years of leadership experience required.
Director Hospice Inpatient Unit Opportunity Job Responsibilities
- Manage the day-to-day operations of the unit.
- Oversees budgets, manages interdisciplinary team (IDT), coordinating the providers, and ensuring compliance with regulatory entities.
- Cultivate a positive work environment and promote professional development through coaching, mentoring, and ongoing training initiatives.
Position Details
Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 892 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.
Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.
Active - Benefit Eligible and Accrues Time Off
Work Hours per Biweekly Pay Period: 80.00
Shift: Flexible Hours and/or Flexible Schedule
Location: 210 South Florida Avenue Lakeland, FL
Pay Rate: Min $24.73 Mid $30.92
Position Summary
Under the direction of the Coding and Clinical Documentation Improvement Manger , reviews clinical documentation and diagnostic results, as appropriate, to extract data and apply appropriate ICD-10-CM, CPT, and/or HCPCS codes and modifiers to outpatient encounters for reimbursement and statistical purposes. Communicates with physicians, physician advisor or other hospital team members as needed to obtain optimal documentation to meet coding and compliance standards. Abstracts clinical and demographic information in ICD-10 CM, CPT, and HCPCS codes and modifiers into the computerized patient abstract, Participates in ongoing continued education to assure knowledge and compliance with annual changes.
Position Responsibilities
People At The Heart Of All That We Do
- Fosters an inclusive and engaged environment through teamwork and collaboration.
- Ensures patients and families have the best possible experiences across the continuum of care.
- Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
Safety And Performance Improvement
- Behaves in a mindful manner focused on self, patient, visitor, and team safety.
- Demonstrates accountability and commitment to quality work.
- Participates actively in process improvement and adoption of standard work.
Stewardship
- Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
- Knows and adheres to organizational and department policies and procedures.
Standard Work Duties
- Determines whether the coding assigned was properly assigned based upon clinical indicators and review of the medical documentation and application of coding guidelines.
- Develop and apply appeal arguments to defend the coding and clinical decisions while being able to address and refute the coding determination made by the carrier/payer.
- Drafts appeal letters, including the coding argument with clinical and coding references, to support the coding decision. This may include providing additional medical record documentation.
- Identifies areas for education to improve complete and accurate coding and billing and provide feedback to management regarding trends or patterns noticed in the coding for discussion.
- Continued follow-up on denials as payers may continue to deny. Collaboration with Physician Advisor as required to continue appeal process.
- Continuously reviews changes in coding rules and regulations including in Coding Clinic, CMS, and other payer guidelines.
- Complete denials/appeals reports for leadership.
- Documents all findings in the denials management application and routes to the appropriate person in the workflow for follow-up.
- Assigns and sequence documents all findings in the denials management application and routes to the appropriate person in the workflow for follow-up.s diagnostic and procedural codes using appropriate classification systems utilizing official coding guidelines.
- Performs special projects and/or other duties as assigned.
Competencies & Skills
Nonessential:
- Computer Experience, especially with computerized encoder products and computer-assisted coding applications.
- Requires critical thinking skills, organizational skills, written and verbal communication skills, decisive judgment, and the ability to work with minimal supervision
- MS-DRG and APR-DRG methodology expertise required. Strong knowledge of ICD-10-CM, ICD-10-PCS, POAs, HACs, PSIs, SOIs, ROMs and mortality rates as well as physician queries.
Qualifications & Experience
Nonessential:
- Associate Degree
Essential:
- High School diploma with Associate Degree from accredited HIM program or certificate in coding from an accredited college.
Other information:
Certifications Essential: CCS
Certifications Preferred: Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA).
Experience Essential: 2-5 years acute care hospital inpatient coding experience within the past five years.
Job Summary:
It is the responsibility of the Administrative Supervisor to ensure and maintain adequate and competent levels of patient care in all areas of operation. The Administrative Supervisor collaborates with the Asst. VP of Nursing/Patient Care Services and the VP of Nursing/Patient Care Svc. in facilitating nursing care. This individual assumes responsibility for all administrative activities in the absence of the administrator on premise. The Administrative Supervisor is guided by a broad knowledge of current nursing theory and practice and of principles of management and supervision.
Responsibilities:
- Plans, organizes, and directs nursing services to provide continuity of patient care
- Plans and organizes work to obtain effective use of professional, ancillary and support services and/or equipment to ensure adequate and competent patient care
- Demonstrates critical thinking skills in problem solving
- Interprets policies and procedures to nursing staff
- Provides informal on-the-job training and guidance to all nursing staff to develop and maintain safe nursing practices
- Assumes responsibility for Nursing Department in absence of the Assistant Vice President for Patient Care and the Vice President for Patient Care Services
- Disciplines staff as warranted. Recommends on- going disciplinary actions to Assistant Vice President for Patient Care Services and the appropriate Nurse Manager
- Maintains adequate and safe levels of staffing in emergency situations (e.g., inclement weather) so as not to compromise level of patient care
- Communicates effectively with staff, patients, visitors and peers
- Supervises and assess unit staff in areas assigned
Requirements:
- NYS RN License Required
- Bachelor’s Degree Required, Master’s Preferred
- Ability to manage multiple tasks and projects at various stages of development
- Must demonstrate good organizational skills and ability to set priorities
Education
Required
Bachelor of Science or better in Nursing.
Licenses & Certifications
The Claims Manager is responsible for overseeing the end-to-end claims operations within the MSO managed care delegated functions. This role provides guidance on healthcare claims adjudication and payment processing for Medi-Cal, Medicare, PACE, and other lines of business based on member Evidence of Coverages (EOC) and CMS/DHCS guidelines, ensures that claims are processed accurately, timely, and in compliance with regulatory requirements and contractual obligations. The Claims Manager will lead the claims team, implement process improvements, and collaborate with internal and external stakeholders to optimize claims adjudication workflows.
This role requires high-level of decision-making and problem-solving skills in relates to claims operations, compliance, and process improvements. Deep understanding of Medi-Cal, Medicare Advantage, PACE, CMS, and DHCS regulations; ensuring full compliance across the department. Ability to manage multiple priorities, oversee department workflows, and optimize resource allocation. Responsible to design training programs for claims teams and leads initiatives to enhance team expertise. Excellent communication skills to interact with leadership, payers, providers, auditors, and MSO internal departments.
ESSENTIAL JOB FUNCTIONS:
- Oversee managed care claims processing, ensuring compliance with CMS, DHCS, and health plan guidelines.
- Monitor claims adjudication, ensuring accuracy, timeliness, and regulatory adherence.
- Develop and implement policies and procedures to improve claims processing efficiency.
- Work with IT and system vendors to optimize claims processing systems and troubleshoot issues.
- Lead and mentor the claims team, including Claims Supervisors and processors, ensuring high performance and engagement.
- Conduct regular performance evaluations, design training programs, provide training, and develop staff competencies.
- Establish and monitor productivity metrics to enhance team efficiency.
- Serve as the primary liaison with health plans, providers, auditors, and third-party administrators to resolve claims issues and disputes.
- Manage escalations, appeals, and grievances related to claims processing.
- Coordinate with provider relations to address claims denials and payment disputes.
- Identify areas for process improvement and implement best practices to enhance claims adjudication.
- Analyze claims data, trends, and key performance indicators to drive operational enhancements.
- Prepare reports for senior management on claims performance, backlog, and issue resolution.
- Direct supervision of a department involving responsibility for results in terms of costs, methods and personnel. Responsible for carrying out supervisory/managerial responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing and hiring of employees; planning, assigning, scheduling, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
- Performs other job duties as required by manager/supervisor.
QUALIFICATIONS:
- Bachelor's degree in business, healthcare administration, or related field is preferred; Associate’s degree may be considered with relevant, equivalent work experience.
- Experience: Minimum of 5 years in managed care claims and compliance field, with at least 3 years in a managerial role within an IPA, health plan, medical group, or TPA.
- Knowledge of: Medi-Cal and MA claims processing, CMS and DHCS regulations, capitated vs. fee-for-service (FFS) models, claims adjudication systems (e.g., EZ-CAP, HealthEdge, Tapestry, or similar).
- Skills: Strong analytical, problem-solving, and leadership skills. Proficiency in Excel, reporting tools, and claims systems.
- Certifications (Preferred): AAHAM, CPC, or other relevant claims-related certifications.
LANGUAGE:
- Must be able to fluently speak, read and write English.
- Fluency in other languages are an asset.
STATUS:
- This is an FLSA Exempt position.
- This is not an OSHA high-risk position.
- This is a full-time position.
NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).
Business Development Representative — Medicaid Network Growth
Compass Care Management, LLC is a Florida-based Management Services Organization dedicated to the Medicaid population. Our affiliate network is built around the communities that need care most — with over 80% of our partners being Federally Qualified Health Centers and pediatric practices across Florida.
We are hiring one Business Development Representative based in Broward County to identify, engage, and recruit independent providers, FQHCs, and pediatric practices to affiliate with the Compass Care Management network.
This is a pure growth role — you are not managing existing accounts. You are out in the community building relationships and bringing high-impact affiliates into the Compass Care Management network.
What you'll do:
• Build and work a pipeline of FQHCs, pediatric practices, and Medicaid PCPs across Broward County
• Conduct in-person provider visits and present the Compass Care Management affiliate value proposition
• Guide recruited practices through the affiliate onboarding process
• Attend community health events, FQHC forums, and Medicaid network meetings
• Track all activity in CRM and report weekly on membership growth metrics
What we're looking for:
• 3+ years in provider relations, provider recruitment, or healthcare business development
• Hands-on experience with Florida Medicaid — specifically FQHCs and/or pediatric practices
• Prior experience as a Provider Relations Rep at a Medicaid managed care health plan is a strong plus (Sunshine Health, Simply Healthcare, Molina, Humana Medicaid, Florida Blue)
• Proven ability to build trust with physicians and health center administrators
• Bilingual English/Spanish strongly preferred for this territory
• Valid Florida driver's license; regular local travel required
• CRM-proficient and accountable to metrics
Compensation:
This role offers a competitive base salary of $45,000–$55,000 plus a lucrative performance-based incentive package tied to network growth results. Incentives are structured to reward meaningful impact — representatives who hit their targets can expect total compensation of $90,000–$110,000 or more.
Benefits:
• Medical insurance
• 401(k) — coming soon
• 10 days PTO + holidays
• $500/month vehicle allowance (effective after your onboarding period)
If you have deep roots in the Broward County Medicaid community and a track record of building provider relationships, we want to hear from you.
To apply: Submit your resume and a brief note on your experience in Florida Medicaid provider relations.
Compass Care Management, LLC is an equal opportunity employer committed to building a team that reflects the communities we serve.
Across our growing organization, we embrace diversity in backgrounds and experiences. Improving patient lives around the world is a priority, and we need people from all backgrounds and swaths of life to help build the future of the healthcare and the life sciences industry. We believe our people make all the difference in cultivating an inclusive culture that embraces our cultural beliefs. We are deliberate and self-reflective about the kind of team and culture we are building. We look for team members that are not only strong in their own aptitudes but also who care deeply about EVERSANA, our people, clients and most importantly, the patients we serve. We are EVERSANA.
Job Description
THE POSITION:
Eversana is currently looking for a Senior MuleSoft Developer with strong technical leadership and hands-on integration experience. In this role, you will drive the design and delivery of high-impact API integrations that support core business processes across Patient Services and Pharmacy. You will be joining a fast paced, supportive, growing, collaborative, and balanced team. You will be transparently communicating to all levels of the organization as well as to clients and partners.
The ideal candidate will bring deep expertise in MuleSoft Anypoint Platform, along with a strong understanding of system interoperability within regulated healthcare and pharmaceutical environments.
Essential Duties And Responsibilities
Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by:
- Design and develop integration solutions using MuleSoft Anypoint Platform.
- Build APIs (System, Process, and Experience layers) adhering to API-led connectivity principles.
- Develop RAML specifications, flows, connectors, and error handling strategies.
- Collaborate with Solution Architects and Business Analysts to align technical solutions with business goals.
- Develop reusable assets, templates, and reference implementations to support platform scalability and maintainability.
- Ensure compliance with data privacy and security regulations (HIPAA, HITRUST) and support GxP validation processes.
- Support CI/CD automation, monitoring (e.g., Splunk, CloudWatch), and error handling strategies for production readiness.
- Participate in sprint ceremonies and contribute to platform roadmap, capacity planning, and performance tuning.
- Provide production support, troubleshooting, and issue resolution for integration services.
- Strong analytical and problem-solving skills.
- Experience using Agile, Scrum and iterative development practices
- Mentor and enable other members of the team.
- Collaborate with business and technical stakeholders as needed for gathering requirements, deliver integration solutions.
- Be able to work independently on a project but also collaborate with other solution architects, Leads and stakeholders to exchange information and expand overall knowledge in the practice
- Manage time expeditiously in a fast paced, growing, and continuously changing environment. Be able to focus on delivery regardless of environmental distractions
- All other duties as assigned
- Good to have MuleSoft Integration/Platform Architect certification
- Enjoys working on multiple projects at a time
- Be able to communicate at all levels of the organization
- Continuous learner and Team player
- Strong communicator at all levels of the organization and to clients and partners
An individual in this position must be able to successfully perform the expectations listed above.
Qualifications
MINIMUM KNOWLEDGE, SKILLS AND ABILITIES:
The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required.
- BS in Computer Science, Analytics, Business Intelligence, related field or equivalent experience
- Strong prior IT background as a developer, technical analyst, application support and or administrator
- Relevant experience in MuleSoft 5+ years
- Strong grasp of API architecture (System, Process, Experience), RAML/OpenAPI, OAuth2, and integration best practices.
- Strong understanding of agile and waterfall project delivery methods
- Excellent problem-solving skills, communication, and cross-functional collaboration.
- Integration Architecture experience strongly preferred
- Experience with Anypoint platform and designing integrations using Mulesoft strongly preferred
- Health care (provider, pharmaceutical, and/or health plan) experience strongly preferred
- MuleSoft Certified Developer (Level 1) and/or Integration Architect certification.
- Exposure to microservices, containerization (Docker, Kubernetes), and service mesh architecture.
The physical and mental requirements along with the work environment characteristics described here are representative of those an individual encounters while performing the essential functions of this position.
Office: While performing the essential functions of this job the employee is frequently required to reach, grasp, stand and/or sit for long periods of time (up to 90% of the shift), walk, talk and hear; The noise level in the work environment is usually moderately quiet, with frequent interruptions and multiple demands.
Additional Information
OUR CULTURAL BELIEFS:
Patient Minded I act with the patient’s best interest in mind.
Client Delight I own every client experience and its impact on results.
Take Action I am empowered and empower others to act now.
Grow Talent I own my development and invest in the development of others.
Win Together I passionately connect with anyone, anywhere, anytime to achieve results.
Communication Matters I speak up to create transparent, thoughtful and timely dialogue.
Embrace Diversity I create an environment of awareness and respect.
Always Innovate I am bold and creative in everything I do.
Our team is aware of recent fraudulent job offers in the market, misrepresenting EVERSANA. Recruitment fraud is a sophisticated scam commonly perpetrated through online services using fake websites, unsolicited e-mails, or even text messages claiming to be a legitimate company. Some of these scams request personal information and even payment for training or job application fees. Please know EVERSANA would never require personal information nor payment of any kind during the employment process. We respect the personal rights of all candidates looking to explore careers at EVERSANA.
EVERSANA is committed to providing competitive salaries and benefits for all employees. If this job posting includes a base salary range, it represents the low and high end of the salary range for this position and is not applicable to locations outside of the U.S. Compensation will be determined based on relevant experience, other job-related qualifications/skills, and geographic location (to account for comparative cost of living). More information about EVERSANA’s benefits package can be found at /careers. EVERSANA reserves the right to modify this base salary range and benefits at any time.
From EVERSANA’s inception, Diversity, Equity & Inclusion have always been key to our success. We are an Equal Opportunity Employer, and our employees are people with different strengths, experiences, and backgrounds who share a passion for improving the lives of patients and leading innovation within the healthcare industry. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion, and many other parts of one’s identity. All of our employees’ points of view are key to our success, and inclusion is everyone's responsibility.
Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of EVERSANA to provide reasonable accommodation when requested by a qualified applicant or candidate with a disability, unless such accommodation would cause an undue hardship for EVERSANA. The policy regarding requests for reasonable accommodations applies to all aspects of the hiring process. If reasonable accommodation is needed to participate in the interview and hiring process, please contact us at
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Health Plan Coding Contractor (Dental & Vision Experience Preferred)
Role Type: Contract
Experience Level: 2 - 3 year minimum preferred
Work Arrangement: Remote eligible (certain time zones preferred)
Hourly Rate Range - $30 / hour - $34/hour
Overview
We are seeking two Health Plan Coding Contractors to support backend medical benefit configuration and coding for health plan implementations. One of the roles requires specific experience in dental and vision coding.
These contractors will work closely with internal operations teams and implementation stakeholders to build, configure, and maintain accurate benefit structures within a health plan platform. The work involves handling protected health information (PHI), reviewing plan documents, and translating benefit details into coded system configurations.
Candidates should be comfortable working in a collaborative environment with operational leaders while also managing technical coding responsibilities independently.
Key Responsibilities
Health Plan Coding & Configuration
- Perform backend medical benefit coding and configuration within the claims adjudication system.
- Translate complex plan documentation such as Summary Plan Descriptions (SPDs) and Evidence of Coverage (EOC) into accurate system configurations.
- Support the build and implementation of member benefits based on plan documentation and contractual agreements.
- Work with internal teams to ensure coded benefits align with operational and compliance requirements.
Quality Assurance & Compliance
- Conduct validation and quality checks to ensure coding accuracy, consistency, and compliance with applicable regulations.
- Perform audits on coded benefits to ensure correct implementation across systems.
- Identify and resolve edge cases or complex benefit scenarios affecting claim processing.
Cross-Functional Collaboration
- Partner with internal operational managers on backend initiatives and process improvements.
- Work closely with implementation and launch teams responsible for onboarding new health plans and coordinating with insurance partners.
- Collaborate with operations teams to support benefit updates, claim processing accuracy, and issue resolution.
Process & Workflow Support
- Assist with workflow processes related to benefit configuration changes, including:
- Creating system rules to pause impacted claims when updates are required
- Conducting manual review to ensure proper claim adjudication
- Monitoring results before releasing claims back into automated processing
Required Qualifications
- Minimum 2years - 3 year of experience in medical coding, health plan coding, or benefit configuration.
- Experience working with health plan benefit structures or claims systems.
- Dental and vision coding experience required for one role.
- Familiarity with payer or third-party administrator (TPA) environments is preferred.
- Strong attention to detail and ability to interpret complex plan documentation.
- Ability to manage tasks independently while collaborating with cross-functional teams.
Preferred Qualifications
- Experience working with enterprise benefit platforms such as Facets, QNXT, HealthRules, or similar systems.
- Knowledge of healthcare regulatory frameworks affecting benefit design and claims processing.
- Prior experience supporting health plan implementations or benefit builds.
Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.
