Monument Health

Role Description States eligible for remote work: SD, FL, GA, KY, OH, SC, TN, TX, VA, WY. Perform duties necessary to ensure the proper interpretation, processing, recording, approval and payment of inpatient and outpatient medical claims. Accurately reviews information for processing claims into a computerized system in accordance with the primary payer specifications and billing guidelines. Essential Functions: - Demonstrates application of compliance standards and payer specific data to properly file claims and ensures prompt, appropriate reimbursement of services and supplies billed to third parties and appropriate payment of services and supplies due from patients, as evidenced by documentation, observation and feedback. - Demonstrates a working knowledge of third party payer procedures including, but not limited to: Commercial Payers, Veterans Administration, worker' compensation, third-party liability, county payers, and all other third party contractual agreements as required. - Conducts timely follow up of claims. Use tools provided to track and trend patterns of claim submission issues that might require Compliance and Charge master staff to resolve, or HIPAA transaction code set review. Research payer requirements and offer suggestions to leadership for claims submission issues. - Maintains and updates appropriate system documentation to provide information regarding claim processing to internal or external customers. - Identifies unresolved requests of patient responsibility and transfers account to self pay. Performs duties and provides best customer service using behaviors that demonstrate responsibility and accountability. - Participates in departmental activities related to performance improvement and quality control. - Demonstrates a working knowledge of denial follow up and first level appeals. - All other duties as assigned. Qualifications - Education - High School Diploma/GED Equivalent in General Studies - Preferred Experience - 1+ years of Clerical Experience; 1+ years of Medical Patient Accounts/Financial Services Experience - Preferred Education - Bachelors degree in Accounting, Business, Health Related Field - Preferred Certifications - Certified Clinical Account Technician (CCAT) - Accredited University or accredited training professionals; Certified Patient Account Technician (CPAT) - Accredited University or accredited training professionals Requirements - Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Benefits - Supportive work culture - Medical, Vision and Dental Coverage - Retirement Plans, Health Savings Account, and Flexible Spending Account - Instant pay is available for qualifying positions - Paid Time Off Accrual Bank - Opportunities for growth and advancement - Tuition assistance/reimbursement - Excellent pay differentials on qualifying positions - Flexible scheduling

Role Description Coordinates, completes and provides supervision for the primary operational functions of Medical Staff Services including but not limited to credentialing, privileging, proctorship, and orientation. Serves as a resource for the VPMA, Medical Staff, and others. Applies knowledge of regulatory/accreditation standards to maintain Medical Staff and Hospital compliance. States eligible for remote work: SD, FL, GA, KY, OH, SC, TN, TX, VA, WY. Essential Functions - Compiles credentialing, privileging, and peer review actions for the Board of Directors’ Quality Committee. - Acts as resource and assists Department Chairpersons and Credentials Committee members to obtain information required when they review the application. - Plans, organizes and directs confidential research required for initial appointees and recredentialing/reappointment (physicians, dentists, AHPs). - Develops and provides oversight for the orientation program for new appointees (physicians, dentists, and AHPs). - Maintains and updates the proctorship review forms, files, and process to maintain compliance with regulations outlined by the Joint Commission and other agencies. - Assists in the VPMA and Bylaws Committee in maintaining and revising pertinent documents. - Responds timely and appropriately to Joint Commission and other surveys, coordinates successful completion, and assists in the development of any necessary action plans. - Evaluates document revisions for Joint Commission and other regulatory compliance. - Utilizes the MIDAS database efficiently and effectively for tracking, reporting, and other processes. - Assists the VPMA, Medical Staff, and others with special projects as requested. - All other duties as assigned. Qualifications - Education - High School Diploma/GED Equivalent in General Studies - Preferred Experience - 1+ years of Healthcare Experience; 1+ years of Medical Staff Experience; 1+ years of Regulatory Guidelines Experience - Preferred Education - Associates degree in Healthcare - Preferred Certification - Certified Provider Credentialing Specialist (CPCS) - Accredited University or accredited training professionals Requirements - Physical Requirements: Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Benefits - Supportive work culture - Medical, Vision and Dental Coverage - Retirement Plans, Health Savings Account, and Flexible Spending Account - Instant pay is available for qualifying positions - Paid Time Off Accrual Bank - Opportunities for growth and advancement - Tuition assistance/reimbursement - Excellent pay differentials on qualifying positions - Flexible scheduling Company Description Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.

Role Description The Patient Services Specialist plays a vital role in ensuring timely and accurate patient access to medical services by managing the prearrival prior authorization services. This position enhances patient access to care by ensuring all scheduled medical service requests and referrals are financially cleared prior to the date of service provision through the performance of insurance eligibility validation, plan benefit verification, and any related financial clearance, prior authorization, and pre-determination processes. - Collaborate with healthcare providers, clinical staff, and various departments throughout Monument Health as well as with the patient to secure necessary authorization for services while maintaining compliance with all regulatory requirements. - Accurately verify patient insurance eligibility and benefits coverage, utilizing tools such as Electronic Health Records (EHR), add-on software, direct payer websites, and telephone or fax communications to ensure accurate reimbursement and compliance. - Assess service requests to determine the need for pre-certification, pre-authorization (procedure or medication), or referrals, and communicate effectively with relevant stakeholders to secure approvals prior to the date of scheduled services. - Maintain a strong working knowledge of various insurance payers, payer plans, and program contract requirements to facilitate appropriate insurance verification and authorization processes. - Continuously meet competency requirements to sustain the necessary skills, knowledge, and abilities for role-specific functions, while adhering to productivity and quality performance standards. - Create a positive service experience by being polite, compassionate, and professional with all internal and external customers. - Document pre-authorization information accurately in the EHR system, ensuring that services scheduled by internal and external providers meet all financial clearance criteria and have approved authorization in the time allowed by the payers and programs to prevent denial or penalty assessment. - Engage with departments and clinical staff to communicate the need for pre-authorizations or referrals promptly, working to prevent delays in patient care. May include requests for assistance with managing appeals as well as the facilitation and coordinating peer-to-peer reviews when needed. - Identify high-risk requests that may require financial assistance and counseling and assist patients by providing guidance on available resources, financial assistance, or payment arrangements. - Advocate for patients and providers by addressing challenges related to pre-authorization approvals and denials, working closely with leadership to resolve issues and ensure compliance with financial clearance policies. - Provide backup support for Patient Admissions and Registration as needed. - All other duties as assigned. - Confirm prescription coverage and coordinate prior authorization, including collecting and submitting required clinical documentation (i.e. provider notes, labs and treatment history). - Stay up to date on patient assistance programs and guide patients through required application documentation. - Coordinate with providers and nursing staff to obtain required signatures and documentation from patients and providers. - Serve as a patient advocate by regularly communicating with pharmaceutical companies, providers and patients. - Act as primary contact for patient inquiries about medication authorizations and assistance programs. - Monitor assistance medications to ensure timely delivery and continuous patient access. - All other duties as assigned. Qualifications - Education - High School Diploma/GED Equivalent in General Studies - Preferred Experience - 1+ years in Health Care Services, Customer Service, Patient Scheduling, Patient Billing Experience - Preferred Education - Associates degree in Healthcare Related Field Requirements - Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. - Sedentary work involves sitting most of the time. - Possible exposure to blood, bodily fluids, or tissues. Benefits - Supportive work culture - Medical, Vision and Dental Coverage - Retirement Plans, Health Savings Account, and Flexible Spending Account - Instant pay is available for qualifying positions - Paid Time Off Accrual Bank - Opportunities for growth and advancement - Tuition assistance/reimbursement - Excellent pay differentials on qualifying positions - Flexible scheduling