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Clinical Eligibility Reviewer

2 months ago

Atlanta, United States Recora Full time
Mission

Empower everyone to live a long, full and optimal life by redefining the future of heart health.

1 in 3 humans die of heart disease - it's time to change that.

We're designing heart health from the ground up so that humans can live fuller lives. We're building technology to accelerate recovery after a cardiac event. And we're optimizing health stacks to realize preventive and aspirational goals.

Recora is redefining the future of heart health — we invite you to join us on this mission.

About Recora

Recora was founded in 2020 by seasoned digital health entrepreneurs. In past roles, we've founded and scaled high-growth startups, run large health systems, advised government programs, built technology you use every day, and provided healthcare for millions of lives.

We're backed by leading VCs including SignalFire, Pear, GFC , 2048, Great Oaks, MGV and more. Over the last year, we've built the leading virtual cardiac recovery and management platform for members with cardiac conditions. For every member we serve, we add an average of five years to their lifespan.

We're growing – fast. Our member base is doubling every month and we're looking to 3x our team size quickly. This will allow us to scale nationally and accelerate product development across the continuum of heart health.

Who We Are

We are innovators at heart. This driving force guides us to create, build, partner, and operate at the highest levels. We seek answers to some of the hardest problems in technology and healthcare and enjoy the process of finding unexplored solutions.

We're a group of diverse, thoughtful and humble folks. Having worked in organizations of every size and shape, we know that people make or break teams. An open, ego-free and supportive culture is central to making the best team of people at Recora.

As a team, we love our work and love working together. We take ownership in Recora and strive to grow personally and professionally in service of our mission. Because we enjoy hard problems and value growth, we can celebrate both challenges and excellence in equal measure.

Job Title: Clinical Eligibility Reviewer *(LPN or RN Required)

Classification: Part Time/1099 Contractor

Work Structure: Fully Remote

Shift: Monday-Friday; 3-5 hours per day/15-20 hours per week*; within 8am-5pm timeframe** (local time); Evening shift also available (3pm-8pm EDT)

Team: Clinical Operations

Reporting to: Program Manager

Location: United States

Compensation: $25 per hour

  • (Additional hours may be available as enrollment projects arise to focus on specific target populations)
  • (must be available for eligibility/enrollment team meetings)

About Us:

One in three people die of heart disease - it's time to change that. We're redesigning heart health from the ground up so that everyone can live fuller lives. Our team consists of mission-driven clinicians, engineers, and professionals attacking a problem using evidence-based research and guidelines for cardiovascular rehabilitation. We're working to deliver exercise and wellness for the older adult cardiovascular disease using telemedicine. We are dedicated to delivering exceptional services that enhance the lives of our patients.

Job Summary:

The Clinical Eligibility Reviewer will be responsible for reviewing the EMR records of cardiac recovery patients to determine medical eligibility/ineligibility for Recora Health. This position is responsible for:

  • Providing daily clerical support to enrollment team by reviewing patient charts for medical eligibility/ineligibility
  • Identifying current cardiac rehab referral orders or creating cardiac rehab referral orders when needed
  • Communicating patient eligibility and ineligibility to enrollment team through concise documentation within appropriate platforms
  • Patient registration review and insurance benefits verification
  • Special projects as needed

This position requires the ability to learn and retain a broad base of knowledge concerning all examinations and make quick, independent decisions using good judgment.

Qualifications:

  • LPN or RN credential required
  • 3-5 years of clinical experience in cardiac care required
  • EPIC or general EMR: 3 years
  • Medical terminology: 1 year
  • Proficient computer skills, including experience with Zoom, Google Suite, and EPIC EMR preferred
  • Strong written and verbal communication skills
  • Excellent clinical assessment and analytical skills

Requirements:

  • Citrix
  • EPIC access RTE
  • Zendesk
  • Google Suite
  • Zoom
  • Teams (required for GHS Epic training)
  • TIBCO (for verification of OON referrals)

SOPs:

  • Clinical eligibility check process
  • Inclusion/exclusion list
  • Decision tree
  • ICD code list
  • ZD macros