Careers

About:

The successful candidate will have a proven track record of conducting nutrition assessments, identifying patients at risk and creating diet plans. You should be able to analyze the effectiveness of interventions and use metrics to implement data-driven improvements. You should also actively keep up with the latest nutritional research, integrating new findings into diet plans and nutritional services. The ideal applicant has experience providing nutrition education to patients and mitigating risk factors. You must be ready to collaborate with physicians, therapists and nurses in order to tailor dietary services and improve patient outcomes. The Registered Dietitian should be a great communicator, critical thinker and leader.

Salary: $60,000 - 80,000/year

Responsibilities:

• Evaluate the nutritional status of each patient by reviewing their case history and records and conducting a thorough assessment with the patient.
• Create a proper dietary plan suitable to their current health state and/or recommend the ideal nutritional program to them.
• Provide quality counseling to the patient and their family members.
• Accurate documentation of progress notes, charts, referrals and communicate reports to supervisor and other members of the team.
• Consistent updating of the progress of patients; able to gather and analyze information precisely and skillfully.
• All other duties assigned.

Requirements:

• Licensed as a Registered Dietitian
• 2+ years of Nutritionist/Dietitian experience highly
• 1+ year of Plant-Based / Vegan Diets experience
• Basic knowledge of Microsoft Office
• Possession of excellent interpersonal, time management, problem-solving and self- initiation skills
• Able to work in Sacramento, CA
• Personal or professional understanding of plant based/vegan diet

Duties and Responsibilities:

• Adjudicate both hospital and professional claims in an efficient, cost-effective, and timely manner. Determine financial responsibility between the group, health-plans, and contracted hospitals for accurate processing of claims.
• Interprets contract coverage for medical HMO claims.
• Review and interpret provider contracts to properly adjudicate claims.
• Review and interpret Division of Financial Responsibility (DOFR) for claims processing.
• Perform delegated duties in a timely and efficient manner.
• Verify eligibility and benefits as necessary to properly apply co-pays.
• Strong working knowledge of Medicare and Medi-Cal, OPPS APC, Ambulatory Surgery pricing, and RBRVS payment guidelines.
• Understands eligibility, enrollment, and authorization process.
• Knowledge of prompt payment guidelines for clean and unclean claims.
• Process claims efficiently and maintains the acceptable quality of at least 95% of reviewed claims.
• Meets daily production standards set for the department.
• Prepares claims for medical review and signature review per processing guidelines.
• Identify correct received date on claims, with knowledge of all time frames for meeting compliance for all lines of business.
• Maintains a good working knowledge of system/internet and online tools used to process claims
• Adequate knowledge of CPT/HCPCS/ICD-10, and Revenue Codes, including modifiers.
• Assist customer service as needed to assist in claims resolution on calls from providers.
• Researches authorizations and properly selects appropriate authorization for services billed.
• Coordinate with the claims clerks on issues related to the submission and forwarding of claims determined to be the financial responsibility of another organization.
• Coordinate Benefits on claims for which member has other primary coverage.

Qualifications:

• At least a high school diploma or equivalent
• 3-5 years of claims adjudication of hospital claims experience in a managed Care/IPA environment for Medi-Cal, Medicare, and commercial managed care claims
• Knowledge of the overall claims workflow as well as compliance guidelines
• Knowledge of CPT, HCPCS, ICD-10 codes, and claims processing for HCFA-1500 and UB04 claims
• Strong knowledge of all types of medical claims processing.
• Knowledge of medical terminology
• Must have good verbal, written, and interpersonal communication skills
• Proficient in application and use of Windows, and Microsoft Office (Word, Excel, etc.)

Job Type: Full-time

Pay: $20.00 - $32.00 per hour

Experience:

• DOFR healthcare plan: 1 year (Required)
• Claims adjudication of hospital claim: 3 years (Required)
• Microsoft Excel: 2 years (Required)

Duties and Responsibilities:

• Manage and oversee the Compliance department
• Must have an innate and intuitive knowledge of a company’s goals and culture
• Complete annual Health Plan audits
• Maintain training records and education completed by employees
• Attend quarterly board meetings and investigate and resolve compliance concerns
• Lead Compliance Committee meetings
• Educating the entire company and instituting practices that will ensure the highest possible level of healthcare compliance
• Determine how an organization is managed, governed and directed, including the relationships between stakeholders and the structure by which company objectives are followed and set
• Communicate compliance-related issues to employees across all divisions of the organization and to our Health Plan partners
• Must have extraordinary people skills and can communicate and cooperate up, down and across the employee chain
• Must have a firm grasp of the business
• Knowledge of Federal and State regulations and policies
• Creation/revision of applicable healthcare policies and procedures
• Must be knowledgeable with HIPAA Law, Healthcare IT, Medicare, and Medicaid

Qualifications:

• At least 2-3 years of healthcare compliance officer experience
• Bachelor’s degree in any healthcare field is required
• Must have a background in healthcare technology and healthcare compliance
• Strong understanding with HIPAA Law, Medicare and Medicaid
• Centers for Medicare and Medicaid Services (CMS) experience is a big plus!
• Must have strong leadership abilities
• Advanced computer skills and excellent written and oral communication skills
• Able to work in Sacramento, CA
• Authorized to work in the US.

Job Type: Full-time

Pay: $100,000.00 - $140,000.00 per year

Experience:

• Healthcare technology and healthcare compliance: 2 years (Required)
• HIPAA Law, Medicare and Medicaid: 2 years (Required)
• Healthcare compliance officer: 2 years (Required)

Compensation Range: $16.00 - $18.00 an hour

Duties and Responsibilities:

Providing general insurance claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims.

• Recognizing claims by determining claim type
• Reviewing and researching claims forms and documents for accuracy and completion and obtaining missing information as necessary
• Authorizing the appropriate payment or refers claims to investigators for further review
• Transmitting claims for payment or further investigation
• Calculating and adjusting claims amount as necessary
• Determining claims coverage by examining company records
• Conducting data entry, updating, and maintaining claims tracking database
• Analyzing and identify trends and provide reports as necessary
• Reading and interpreting DOFRs
• Consistently meet established productivity, schedule adherence, and quality standards
• Other duties as assigned

Qualifications:

• Must have at least one year of experience in claims processing
• High school diploma or equivalent (GED)
• Basic knowledge of Healthcare industry guidelines
• Basic knowledge of the Health insurance industry
• Basic knowledge of refund requests and appeals
• Knowledge of the different types of claims in relation to medical and hospital HMO claims
• Effective research and problem-solving skills, and ability to multitask
• Has excellent communication skills and attention to detail
• Able to work unsupervised
• Able to work in Sacramento, CA
• Authorized to work in the US

Compensation Range: $23.00 -$31.00 an hour

Duties and Responsibilities:

The Claims Auditor is responsible for processing pre and post-payment adjudication audits of claims, ensuring quality assurance and compliance with rules and regulations, suggest process improvements to management, and act as a resource of information.

• Conducting pre and post-payment adjudication audits of claims
• Identifying incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims
• Conducting quality assurance audits for claim adjustments, refunds, and provider disputes
• Completing and maintaining detailed documentation of audits including details and citations, and providing reports as necessary
• Investigating audits and giving recommendations to management for improvements based on findings
• Reading and interpreting DOFRs and contracts from both health plans and providers
• Providing guidance and training to the Claims Examiners in relation to claims adjudication
• Meeting key metrics on productivity, financial accuracy, and regulatory compliance
• Other duties as assigned

Qualifications:

• Minimum of 5 years experience as a claims examiner
• High school diploma or equivalent (GED)
• Knowledge of the overall claims workflow as well as compliance guidelines
• Has experience processing Medicare, Medi-Cal, and Commercial Managed Care Claims
• Knowledge of Correct Coding Initiative, HCFA-1500, and UB04 claims and coding
• Knowledge of medical terminology
• Must have the understanding to read and interpret DOFRs and Contracts
• Effective research and problem-solving skills, and the ability to multitask
• Has excellent communication skills and attention to detail
• Able to work unsupervised
• Able to work in Sacramento, CA
• Authorized to work in the US

Duties and Responsibilities:

• Man the phones during the day; answering calls from clients/customers
• Manning the phone lines; answering calls from clients/customers
• Setting or scheduling appointments
• Forwarding calls to their respective departments
• All other duties assigned.

Qualifications:

• At least 1 year of experience in customer service; working phone lines
• At least 1 year experience in healthcare customer service.
• Excellent telephone etiquette
• Proficient oral and written communication skills
• Able to multitask and work in a fast-paced environment
• Basic computer knowledge
• Must be bilingual (English and Spanish)
• Preferably located in Sacramento, CA

We are looking for two (2) Utilization Review Nurses for inpatient and outpatient review.

The Utilization Review Nurse will be working within our Utilization Management team to review and authorize requested services,prepare requests for physician review based on medical necessity, communicate with members and providers, and maintain clinical quality for our membership. The position requires analytical skills to successfully evaluate, monitor and assure the appropriateness and medical necessity of care as it relates to quality care.

Responsibilities:

• Reviews designated requests for referral authorizations either proactively, concurrently or retroactively.
• Gathers all information needed to make a determination and/or coordinate with the Medical Director as needed.
• Ensures compliance with turnaround times and accuracy standards.
• Manages UM knowledge for Medi-Cal, Medicare, and Commercial lines of business.
• Promotes quality, cost-effective medical care through strict adherence to all utilization management policies and procedures.

Educational/License Requirements

• Associate's or Bachelor’s degree - Required
• Licensed Vocational Nurse (LVN) or Registered Nurse (RN) in California for Outpatient Review - Required
• Registered Nurse (RN) in California for Inpatient Review - Required

Qualifications and Experience

• At least 5 years of bedside nursing experience
• 2+ years of Utilization Review experience required
• 2 years of clinical experience is preferred.
• Ability to type a minimum of 45 WPM.
• Proficiency with computer and standard business software (MS Office applications) and ability to learn in-house and other systems quickly with minimal training.
• Demonstrated ability to assess, evaluate and interpret medical information.
• Excellent communication skills, including both oral and written.
• Ability to provide and receive constructive job and/or industry related feedback.
• Ability to maintain confidentiality and appropriately share information on a need to know basis.
• Ability to multitask, exercise excellent time management, and meet multiple deadlines.
• Able to work in Sacramento, CA.
• Authorized to work in the US.

Duties and Responsibilities:

• Assists with health plan reports, health plan audits, and internal audits.
• Handles grievances and appeals
• Ensuring compliance with current regulations.
• Monitoring and reporting on all activities, processes, and procedures.
• Preparing and maintaining quality management documentation.

Qualifications:

• Bachelor’s degree in Healthcare related field preferred
• At least 2 years of experience in regulatory/accreditation programs, or health plan operations
• Experience in quality management is preferred
• Previous experience in healthcare, managed healthcare service organization, insurance company, or other health related entity is highly preferred
• Strong organizational skills and detailed orientated
• Proficient in Microsoft Office tools and computer programs
• Able to work in Sacramento, CA.
• Authorized to work in the US.

The Eligibility Specialist analyzes, reviews, and oversees the eligibility lifecycle. Starting with loading all eligibility files to completing an analysis of members who have terminated with our IPA. All eligibility updates/requests are expedited and must be handled within 24 hours. The ideal candidate is dependable, detail oriented, and has a strong work ethic.

Duties and Responsibilities

• Ensuring proper loading of all Health Plan eligibility and capitation files
• Updating the member’s eligibility as requested
• Redetermination review with applicable Health Plans
• Coordinate with the Health Plan on needed changes/updates
• Loading new benefits each year and as needed
• Analyzing member termination reports and identifying any trends
• Identifying and correcting member’s addresses from returned mail
• All other duties as assigned

Qualifications

• Strong attention to detail
• Proficient oral and written communication skills
• Able to multitask and work in a fast-paced environment
• Developing and maintaining Health Plan relationships
• Associates degree preferred
• Minimum of 1 year working in a managed care setting
• Proficiency with Microsoft Excel
• Experience working in capacity as eligibility coordinator or eligibility specialist
• Prefer experience working with Medicare, Commercial, and Medi-Cal insurance.

 Nivano Physicians offers a range of health, dental, and vision benefits. On top of that, we also offer a 401K plan for employees and a competitive PTO policy with many sick days available for use.

 Nivano Physicians offers employees a fully stocked pantry as well as a plant based lunch every Thursday. We also try to plan and sponsor events as often as we can!

Yes! Nivano Physicians strives to create an environment where employees can advance and grow in their positions. We are always looking to grow and as a small company we are finding the need to create new positions to help with growth.