Career
At Rhombus, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.
Who are you?
As a Case Manager you will offer telephonic case management for members experiencing severe or chronic health conditions. We are actively recruiting for on-site Telephonic Case Managers who provide patient education, emotional support, and assistance with care coordination.
Responsibilities:
- Coordinate care and services and develop patient treatment plans for catastrophic cases.
- Telephonically manage cases on a long or short-term basis per established company guidelines, policies and procedures, as well as other standardized criteria in the healthcare industry.
- Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
- Develop treatment plan in collaboration with the patient, caregivers or family, community resources and multidisciplinary healthcare providers that include obtainable short and long term goals. Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
- Initiate and maintain contact with the patient/family, provider, employer group, and multidisciplinary team as needed through the continuum of care.
- Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
- Meet daily productivity requirement.
- Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
- Perform data entry and maintain complete and detailed documentation of case managed patient in the computer system; maintain site specific logs and files, ensuring confidentiality according to company policy and HIPAA.
Requirements:
- Current unrestricted RN license
- California RN License preferred
- Compact License preferred
- 1+ years of case management experience required.
- Computer proficiency and working knowledge of Microsoft Office Suite and Microsoft Outlook required.
- Knowledge of medical claims and ICD-10, CPT, HCPCS coding preferred.
- Knowledge of utilization management/quality management case philosophies and reporting requirements; quality improvement methodologies preferred.
At Rhombus, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.
Who are you?
We’re in search of a RPA Business Analyst to be part of our Intelligent Automation Team that is ready to innovate and explore what’s possible in the world of robotic automation, low-code development, and artificial intelligence (AI). In this role, you’ll work cross-functionally with business operations and RPA Developers to create and optimize workflow processes. You’ll also lead initiatives related to collecting requirements, architecting solutions, document and managing workflow automation projects.
Responsibilities:
- Work with teams in the identification of business requirements, functional design, process design.
- Analyze business processes, identify potential automation opportunities, and propose RPA strategy and low-code applications.
- Create the PDD (Process Description Document), and SDD (Solution Design Document) in detail.
- Updating to RPA stakeholders and other team members during project delivery.
- Work directly with stakeholders to capture business requirements and translate them into technical approaches and designs that can be implemented.
- Work with RPA Developers in development of the automations and low-code applications.
- Maintain current knowledge of relevant technologies and business processes.
Requirements:
- Basic Knowledge of RPA tools and cognitive platforms such as UiPath, Blue Prism, Automation Anywhere, etc. (Automation Anywhere experience is highly preferred).
- Basic Knowledge with low-code platforms like Appia, MS Power Tools, PEGA, Nitex or others.
- Experience with Agile development methodology.
- Knowledge of artificial intelligence and machine learning. (AWS Services Preferred).
- Understanding of workflow-based logic.
- Strong attention to detail and analytical skills.
- Ability to present technical details to non-technical audiences.
- Excellent problem solving/analytical skills and complex troubleshooting methods.
- Ability to work through ambiguous situations.
- Excellent presentation, verbal, and written communication skills.
- Self-motivated, able to work independently, and able to take initiative without always being directed.
- Ability to multitask in a fast-paced environment and prioritize the most critical tasks and projects.
- Logical thinking to find the hidden opportunities of the business processes.
No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!
Who are you?
The purpose of the Provider Database Specialist is to research, analyze and load provider information for accurate payment of claims processing in accordance with provider contracts and PPO information received.
Responsibilities:
- Load provider demographic data & Contract Information for all lines of business.
- Create Fee schedules as required for contracts received.
- Review CMS website for updates to contracts based on Medicare guidelines.
- Work multiple daily reports as received and forward to IT department daily.
- Responsible for tickets related to provider issues in the edit/exception portal and insure they are worked in 5 business days.
- Provide management weekly reports for outstanding and unresolved tickets.
- Perform various other duties assigned by management.
Requirements:
- High School diploma or equivalent.
- 2 years prior claims processing experience and/or provider contract experience.
- Ability to understand and interpret current CPT, ICD10, DRG, and HCPCS coding practices in accordance with Medicare and HIPAA Guidelines.
- Must have strong interpersonal skills and a professional demeanor; ability to work independently on projects as well as contribute to team efforts; and superior communication and organizational skills.
- Accurate data-entry skills.
- Excellent time management skills.
- Proficient with Microsoft applications (Word, Excel, Outlook) and database systems.