Franciscan Health

Title: Prior Authorization Specialist Physician Practice Location: Munster Administrative Building Full time Job Description: Munster Administrative Building 757 45th St Munster, Indiana 46321 The Prior Authorization Specialist is responsible for obtaining prior authorization for provider practices, which may include outpatient services, specialty care and other ancillary services. The Prior Authorization Specialist verifies insurance coverage and gathers clinical information to ensure that all reimbursement requirements are met. WHO WE ARE Franciscan Health is a leading healthcare organization dedicated to providing exceptional patient care and promoting health and wellness in our community. Our mission is to ensure that every patient receives the highest quality of care through innovation, compassion, and excellence. With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers who provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT - Flexible position, work from home 2 days, in person (Munster, IN) 3 days. - Monday through Friday 8:00am to 5:00pm - Training will be 1 month on site (Munster, IN). - Serve as primary contact, educator, and resource for all ambulatory department prior authorization requirements and processes. - Collect clinical and coding information regarding services to be rendered. - Contact payer to obtain prior authorization. - Provide standardized documentation within EPIC to identify prior authorization and the criteria surrounding such authorization; stay informed and research information regarding insurance criteria for prior authorization. - Verify standard documentation and requirements have been met, and advise providers and their clinical staff when issues arise relating to obtaining prior authorization. QUALIFICATIONS - Required High School Diploma/GED - 1 year Prior Authorizations and Revenue Cycle Required TRAVEL IS REQUIRED: Never or Rarely EQUAL OPPORTUNITY EMPLOYER It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

• Reviews and analyzes the content of the medical record • Accurately reviews and codes patient records • Evaluates appropriateness of diagnosis and procedure codes • Reviews clinical documentation to validate accuracy • Identifies and enters data elements for abstracting

• Manage inbound and outbound calls with the goals of accurately scheduling patients • Assess the caller’s needs and respond to ensure the appropriate resolution • Understand when to escalate calls to RN, provider clinic, or PEAC leadership • Proactively escalate areas of concerns or uncertainty relating to provider/ancillary departments

• Ensure follow-up of claims on a timely basis and adhere to contractually binding conditions • Daily review denials and payment discrepancies identified on EOB, RA, or Payer Correspondence • Identify trends of denials, provide documentation and data and offer suggestions for process improvement to resolve issues • Review system work-list, report on a daily basis to resolve accounts, which have not been paid within 30 days of claim submission • Document activity in an accurate and timely manner on the patient account • Maintain follow up procedures and working relationships with departments such as HIM and/or Patient Access • Verify newly received status information and update the patient account • Ensure compliance with all state and federal billing regulations and report suspicious activities to the appropriate person • Work with the department on process improvements to create efficiencies and achieve overall goals

• Schedule and conduct internal and external audits and assessments • Create audit reports; peer reviews audit reports • Create audit methodologies and templates used by the GRC Team • Analyze audit data to identify risks and relationships between threats, controls and vulnerabilities • Formulate prioritized action plans based on audit findings • Track the resolution of negative audit findings • Create and review GRC policies, procedures, and standards • Develop and deliver information security training

Role Description The Data Analytics Engineer 3 is responsible for designing and creating tables within data marts, data lakes, and data warehouses, and all related extraction, transformation, and load of data functions. Their goal is to make data accessible so that organizations can use it to evaluate and optimize their performance. Responsibilities include: - Building systems that collect, manage, and convert raw data into usable information for analytics developers and business analysts. - Developing and testing architectures that enable data extraction and transformation for predictive or prescriptive modeling. - Expanding and optimizing data and data pipeline architecture. - Optimizing data flow and collection for cross-functional teams. - Taking direction and guidance from lead data engineers and department leadership. - Mentoring junior data engineers and guiding users across the organization to promote data education and a data-driven culture. Qualifications - Required Bachelor's Degree in Business, Computer Science, Engineering, Information Systems, Public Health, or related field. - Preferred Master's Degree in Computer Science, Business, Healthcare Management, Information Systems, or related field. - 5 years of experience building data pipelines using ETL technologies such as SSIS or Informatica. - 3 years of SQL development with SQL Server/Oracle environment. - 2 years of experience with cloud data platforms and associated tools such as MS Azure, AWS, or GCP. Requirements - Deep understanding of modern data architectures, including lakehouse design patterns and scalable data processing approaches. - Hands-on experience with Azure data platforms, including ADLS, Azure Data Factory (ADF), Databricks, and related lakehouse technologies. - Strong experience designing and implementing metadata-driven, scalable data pipelines. - Proficiency in Python and PySpark for building data pipelines, transformations, and distributed processing workloads. - Experience integrating data across systems using APIs and other modern data connectivity patterns. - Proficiency with DevOps and DataOps practices, including CI/CD for data pipelines and cloud infrastructure. - Advanced SQL skills with experience managing and optimizing relational data platforms. - Familiarity with Microsoft Fabric is a plus. - Experience with healthcare data platforms such as Epic Cogito is a plus. Benefits - Comprehensive benefit offerings for eligible employees. Company Description With 11 ministries and access points across Indiana, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.

Role Description At Franciscan, our IS Enterprise Digital Solutions Architect ("Architect") is a strategic and hands-on technical leader responsible for designing and delivering enterprise-grade digital solutions across data analytics, automation, interfaces, and AI domains. In this role you will be accountable for creating a cohesive architectural strategy that unifies the organization's technology stack to solve complex business challenges and advance digital transformation. - Lead the architectural vision, reference models, and standards for several domains including data, AI, and automation. - Serve as the Product Owner for prioritized digital, AI, and solutions development initiatives. - Increase the analytics, AI, and solutions development maturity for the organization. - Drive best practices and continuous improvement in various domains. - Effectively lead to promote, deliver, and adopt mature and robust solutions. - Define, articulate, and update the guiding principles that drive the technical standards. - Prescribe and optimize the use of modern platforms and capabilities. - Drive reuse of components, modular architecture, and standardized practices across business units. Qualifications - Required: Bachelor's Degree in Computer Science, Informatics, Computer Programming, Engineering (Computer, Mechanical, Network, or Electrical), Information Security. - Preferred: Master's Degree in Computer Science, Informatics, Computer Programming, Engineering (Computer, Mechanical, Network, or Electrical), Information Security. - 10+ years of hands-on solutions development and architecture across cloud and on-prem environments. - 8 years of custom development experience with deep understanding of IT systems, applications, data structures, and infrastructure. - 8 years of software development/engineering and programming with one or more industry standard languages such as SQL, Python, Java, C++ etc. - 7 years of progressive experience in enterprise architecture or IT strategy roles. - 5 years of experience with cloud-native tools and technologies on Microsoft Azure platform. - 5 years of experience with healthcare enterprise platforms such as Epic, Workday, ServiceNow etc. (Preferred). - 5 years of healthcare technology experience, particularly within hospital systems or integrated delivery networks (Preferred). Requirements - Travel is required: Never or Rarely. - Job Range: IS Enterprise Digital Solutions Architect $117,340 - $161,343.63. Benefits Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

Role Description The Coder VI Specialist- Hospital Inpatient analyzes the ICD 10 codes, suggested by computer assisted coding software, to ensure they align with official coding guidelines and the electronic medical record documentation. In collaboration with the Clinical Documentation Specialist, analyzes the circumstances of the visit to determine the most accurate diagnosis related group (DRG). This position also abstracts key data elements necessary for billing and data analysis. - Schedule: Monday - Friday - Day Shift - Remote - Must reside in an approved hiring state. - Accurately review and code patient records in the following clinical areas: hospital acute inpatient services. - Meet defined coding accuracy and production standards. - Demonstrate a thorough knowledge of coding guidelines, medical terminology, anatomy/physiology, reimbursement schemes, and Payor specific guidelines. - Review and analyze the content of medical records to appropriately assign ICD diagnosis procedure codes, CPT procedure codes, and modifiers to meet coding guidelines. - Notify coding leadership of trends and topics for education and feedback to physicians and departments. - Identify and enter data elements for abstracting. - Participate actively in performance improvement teams, projects, and committees. - Serve as a Superuser and assist with system testing. - Serve as a backup to coding reimbursement specialist. Qualifications - High School Diploma/GED - Required - Associate's degree - Preferred - 2 years Coding - Required - CCS, Certified Coding Specialist from American Health Information Management Association (AHIMA) - Required - RHIT, Registered Health Information Technician from the American Health Information Management Association (AHIMA) - Preferred - RHIA, Registered Health Information Administrator from the American Health Information Management Association (AHIMA) - Preferred Requirements - Travel is required: Never or Rarely - Job Range: Coder VI Specialist - Hospital Inpatient $22.70-$33.77 - Incentive: Not Applicable Benefits Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

Role Description The Coder IV Specialist - Professional Anesthesia and Gyn Oncology - Surgical reviews electronic medical record documentation and applies ICD and CPT codes per Official Coding Guidelines, with a specific focus on professional major surgical services. This position abstracts key data elements necessary for billing and data analysis. - Accurately reviews and codes patient records in the following clinical areas: hospitalist rounds and office visits (with repetitive or non-invasive procedures). - Reviews and analyzes the content of the medical record to determine when documentation should be utilized for appropriate assignment of ICD diagnosis codes, CPT repetitive or non-invasive procedure codes, modifiers, hierarchical condition categories, complications, and comorbidities to meet coding guidelines. - Evaluates appropriateness of diagnosis and procedure codes and modifiers utilized in response to Outpatient Code Editor and National Correct Coding Initiative edits. - Meets defined coding accuracy standards. - Meets defined coding productivity standards. - Remains current with coding and industry changes through participation in educational opportunities. - Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association/American Association of Procedural Coders, and adheres to official coding guidelines. Qualifications - High School Diploma/GED - Required - Associate's or Bachelor's Degree in Health Information Management - Preferred - 4 years Coding - Required - Anesthesia/GYN Oncology Experience - Required - Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) - Required - or Certified Coding Specialist - Physician (CCS-P) - American Health Information Management Association (AHIMA) - Required - or Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) - Required - or Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA) within 180 days - Preferred - or Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) within 180 days - Preferred Requirements - TRAVEL IS REQUIRED: Never or Rarely - JOB RANGE: Coder IV Spcl Professional Specialty Svcs Surgical $20.13-$29.95 - INCENTIVE: Not Applicable Equal Opportunity Employer It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity. Benefits Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

• Design and deliver enterprise-grade digital solutions • Lead the architectural vision and standards • Serve as the Product Owner for digital initiatives • Drive best practices in data applications and automation • Define and update technical standards • Promote and adopt robust solutions for data security and compliance