CommuniCare Health Services

• Manage real time insurance claims while providing customer service to clients • Analyze and approve claims that need to be adjudicated • Determine coverage and apply medical necessity guidelines • Identify and clarify any discrepancies to complete the adjudication process • Work in cohesion with the CIC Department, Prior Authorization, and Billing Departments • Submit claims and add appropriate corrections • Ensure accurate and timely processing of real time claims • Work directly with third party payers for claim resolution • Communicate with facilities on claim issues that will need attention by the facility • Resolve any discrepancies and secure proper reimbursement • Any other duties associated with adjudication • Create Prior Authorizations and notify Authorization team • Follow federal and state regulations • Adhere to company policies and procedures • Follow HIPPA guidelines and regulations

• Coordinate with telehealth providers to ensure appropriate patients receive telemedicine services. • Communicate with onsite nursing teams to ensure all clinical needs are coordinated. • Oversee provider queue in Never Alone. • Support technical issues that arise for telehealth provider team. • Monitor EMR to triage routine clinical lab requests, routine imaging results, notifications, etc. that result after hours. • Maintain timely documentation of encounters with facility nurses in the EMR. • Record information directly into CRM system. • Connect patients that need to be seen acutely by an in-house provider the next day with Central Scheduling. • Answer and triage calls from Never Alone use cases outside of the SNF use case. • Provide health education. • Provide an excellent customer experience to foster high customer satisfaction/retention. • Practice ethically and in accordance with the Scope and Standards of Practice of their profession and Board Certification. • Follow all state and federal regulations, guidelines, and laws. • Collaborate with telehealth provider group. • Participation in monthly staff meetings. • During downtime there may be some additional project related work related to the development of protocols, initial quality review of previous encounters, or projects to be defined as the role evolves.

Role Description The Prior Authorization Specialist will maintain the Prior Authorization’s workflow for a set of facilities assigned by the supervisor, while providing customer service to clients. He/she will enter required information and submit Prior Authorizations to the respective plan, follow the prior authorization to completion, identify and clarify any discrepancies with a prior authorization, and participate in the appeal process. - Work in cohesion with the Adjudication, Claim Intervention and Billing Departments - Submit prior authorizations in accordance with Insurance regulations - Ensure accurate and timely processing of prior authorizations - Work directly with insurance companies for prior authorization resolution - Communicate with facilities to gain additional information - Any other duties assigned - Follow federal and state regulations - Adhere to company policies and procedures - Follow HIPAA guidelines and regulations Qualifications - Prior Authorization experience (not required) - Previous Long-Term Care pharmacy experience a plus (not required) - Knowledge of Framework LTC a plus (not required) Benefits - Competitive salary commensurate with experience - Comprehensive benefits package, including health, dental, and vision insurance - 401(k) with company match - Paid time off - And more

Job Address: 9299 Market Place Broadview Heights, OH 44147 Job Title: Claim Adjudication Department Specialist Reports to: Adjudication Specialist Supervisor Job Type: Full-Time – Remote – Pharmacies located in: West Virginia, Ohio, Indiana, and Maryland Position Overview: As the Adjudication Specialist, you will manage real time insurance claims, while providing customer service to clients. Analyze and approve claims that need to be adjudicated. Determine coverage and apply medical necessity guidelines. Identify and clarify any discrepancies to complete the adjudication process. Key Responsibilities Include but are not limited to: - Work in cohesion with the CIC Department, Prior Authorization, and Billing Departments - Submit claims and add appropriate corrections - Ensure accurate and timely processing of real time claims - Work directly with third party payers for claim resolution - Communicate with facilities on claim issues that will need attention by the facility - Resolve any discrepancies and secure proper reimbursement - Any other duties associated with adjudication - Create Prior Authorizations and notify Authorization team - Follow federal and state regulations - Adhere to company policies and procedures - Follow HIPPA guidelines and regulations Qualifications and Requirements: - Pharmacy Technician License in Ohio, West Virgina, Indiana, and Maryland (All is preferred, but not required) - Previous Long-Term Care pharmacy experience a plus (but not required) - Knowledge of Framework LTC a plus (but not required) Salary and Benefits: - Competitive salary commensurate with experience - Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more

Job Address: 10123 Alliance Road, Suite 320 Blue Ash, OH 45242 MOBILE EMPLOYEE LIFE CYCLE (HR) MANAGER CommuniCare Health Services is a fast-growing health care provider with over 130 facilities in 6 states. That's a whole lot of opportunity for you to join our team and make a difference in the lives of others! This is not your typical healthcare company, and we are not looking for a typical Employee Life Cycle (HR) Manager. The successful candidate will not only have the HR skills, but will also be: - People and engagement focused, and a creative force with a strong ability to recruit - Forward-thinking, open-minded, with a desire to impact change - Goal-oriented, determined, and able to demonstrate continuous improvement in prior Human Resources leadership positions. The Mobile Employee Life Cycle (HR) Manager will be dispatched to locations where additional HR support is needed or there is a vacancy. This is a remote position that can be based near any of our Cincinnati, OH area centers, with travel required to meetings as needed. Mobile ELCM/HR Managers are responsible for: - Focused, professional recruitment efforts that will attract the right people for the right jobs. - Consistent, positive engagement efforts that will create a team of employees who reflect CommuniCare’s core values and know they are respected members of the CommuniCare family. - Ensuring regulatory legal compliance for all relevant federal, state, and local laws and regulations as they apply to all team members. - Recognition that reduces turnover to a minimum. - Supporting managers to enable them to focus on their people as the agents for the special care we give. What We Offer: The position of Mobile ELCM/HR Manager is a full time, salaried position, flexible hours, with salary based on experience. We offer a supportive working environment, competitive wages, PTO plans, and a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts. QUALIFICATIONS: - A degree in Human Resources Management or related field - Certification as SPHR/SHRM preferred - 2+ years’ experience in Human Resources managing personnel - Minimum 2 years’ experience Recruiting - Prior experience in Healthcare required; Long Term Care experience preferred. - Prior experience with ATS systems required. - Strong public speaking and organizational skills - Working knowledge of federal and state employment regulations - Detail oriented, excellent writing, grammar and communication skills Benefits As a CommuniCare employee you will enjoy competitive wages and PTO plans. We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts. About Us Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 130 skilled nursing, assisted living, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 16,000 employees across several states. As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and is a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work, and families to heal.

• Performs Coding audits for compliance and accuracy with all coding systems outlined in the role description. • Completes coding compliance accuracy score tracking, trending, and monitoring. • Completes detailed coding compliance reports which include feedback and education for providers. • Maintains excellent documentation of all reviews, methodologies employed, results, escalation needed, and monitoring. • Provide feedback and education to billers, coders, and providers on documentation and coding practices. • Identify trends, errors, and compliance risks, and recommend corrective actions. • Stay current on changes to coding guidelines, payer policies, and regulatory requirements. • Collaborate with compliance, revenue cycle, and clinical teams to support audit outcomes. • Assist with internal and external audit requests as needed.

• Reviewing cases for Part B therapy appeals • Logging therapy appeal cases in Axis • Submitting therapy appeals to the appropriate payer via their web portals (IE: Availity, Buckeye, Caresource, etc.) • Submitting corrected claims to various Managed Care payers for missing authorization • Following up on appeals with auditing contractors and payers • Submitting write offs on accounts deemed uncollectible • Notating on accounts in PCC in compliance with the dashboard collection policy • Account research as it pertains to cash postings and adjustments • Monitoring the ADR payers • Ensuring proper logging and statusing of all ADRs and therapy appeals in Axis • Assisting with report set up to ensure accuracy of data • Set up for electronic eMDR notification in NPPES/Waystar for Medicare pre and post pay ADRs • Assisting with electronic notification set up for other various ADRs • Calculating at risk amounts for partially favorable ADRs • Required knowledge of updating/changing PDPM/RUG scores in PCC to obtain difference, and knowing what dates of service to change, and appropriately changing back • Other duties as assigned

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The PHP Telehealth Administrator on Call has a passion for providing remote administrative, clinical triage, and care coordination support for the PHP Telehealth provider team, as well as seniors and other residents in a variety of healthcare settings that can include, but are not limited to, skilled nursing facilities, assisted living, and independent living communities. They deliver support in a high touch, person-centered care model and collaborate with the interdisciplinary team to ensure that all residents receive the right care at the right time. The Administrator on Call would directly support both the PHP Telehealth provider group as well as answering calls for triage from other telehealth use cases outside of the Skilled Nursing and Assisted living environments. The goal of the Administrator on Call is to support the Telehealth provider team as well as our patients to increase wellness, prevent illness, improve clinical outcomes and focus on customer experience and satisfaction. Qualifications - Must have valid RN or LPN license - Must be willing to be licensed in the 7 states served (Indiana, Ohio, Maryland, Virginia, West Virginia, and Kentucky) - Excellent communication and critical thinking skills - Good technology aptitude Requirements - Coordinate with telehealth providers to ensure appropriate patients receive telemedicine services. - Communicate with onsite nursing teams to ensure all clinical needs are coordinated. - Oversee provider queue in Never Alone. - Support technical issues that arise for telehealth provider team. - Monitor EMR to triage routine clinical lab requests, routine imaging results, notifications, etc. that result after hours. - Maintain timely documentation of encounters with facility nurses in the EMR. - Record information directly into CRM system. - Connect patients that need to be seen acutely by an in-house provider the next day with Central Scheduling. - Answer and triage calls from Never Alone use cases outside of the SNF use case. - Provide health education. - Provide an excellent customer experience to foster high customer satisfaction/retention. - Practice ethically and in accordance with the Scope and Standards of Practice of their profession and Board Certification. - Follow all state and federal regulations, guidelines, and laws. Benefits - Collaborate with telehealth provider group. - Participation in monthly staff meetings. - During downtime, there may be some additional project-related work related to the development of protocols, initial quality review of previous encounters, or projects to be defined as the role evolves. Company Description Personalized Health Partners (PHP) is the medical practice arm for the CommuniCare Family of Companies.

• Focused, professional recruitment efforts that will attract the right people for the right jobs. • Consistent, positive engagement efforts that will create a team of employees who reflect CommuniCare’s core values and know they are respected members of the CommuniCare family. • Ensuring regulatory legal compliance for all relevant federal, state, and local laws and regulations as they apply to all team members. • Recognition that reduces turnover to a minimum. • Supporting managers to enable them to focus on their people as the agents for the special care we give.

• Manage the insurance claims process • Provide customer service to clients • Analyze and approve claims that cannot be adjudicated • Determine coverage and applies medical necessity guidelines • Identify and clarify any discrepancies to assist in the adjudication process • Ensure accurate and timely processing of rejected claims • Work directly with third party payers for claim resolution • Communicate with facilities on claim issues • Resolve discrepancies and secure proper reimbursement • Follow federal and state regulations • Adhere to company policies and procedures • Follow HIPPA guidelines and regulations