Sanford Health

• Creates marketing plans independently and in collaboration with Lead Marketing Specialists. • Collaborates with all marketing disciplines for marketing plan recommendations and implementation. • Tracks and records marketing activities and results. • Integrates with their enterprise marketing peers to ensure consistent brand delivery. • Manages costs within a predetermined budget. • Participates in cross-functional teams for planning and team collaboration.

• Responsible for processing health insurance claims submitted via paper or electronically by providers and members. • Proficient understanding of Tapestry functionality. • Proficient knowledge to releases health insurance claims for payment, understands claims codes according to the defined workflows. • Proficient in the processing of claim adjustments based on appeals, configuration and/or benefit change. • Basic knowledge of coordination of benefit functions and rules, a basic understanding of third party liability, subrogation and third party processing. • Evaluates claims that need additional information prior to processing. • Determines proper benefit levels that apply to claims per the certificate of insurance and/or the summary of plan documents. • Understands the specific product lines. • Understands accumulators for accurate monitoring of maximum out of pocket expenses for claims processing. • Mentoring of teammates through peer-to-peer conversations. • Processes large quantities of detailed information with high levels of accuracy. • Investigates beneath the surface of an issue to focus systematically on root causes; communicates findings with the Senior Claims Representative.

• Collaborate with Stakeholders: Work closely with management, HR departments, and business subject matter experts (SMEs) to identify, analyze, and document end-user requirements for system improvements and enhancements. • System Design & Development: Generate software design specifications, model and simulate workflows, and develop software solutions by validating designs with users and technical resources. • Customization & Configuration: Develop and configure HRSD components, including record producers, notifications, client scripts, business rules, etc. • Integrations & Automation: Build and manage custom integrations between HR systems using RESTful APIs, SOAP, and other web services. • Testing & Quality Assurance: Perform a variety of testing (manual, automated, functional, performance, integration, regression, load, and stress testing) to ensure that all HR software tools and processes are operating efficiently. • Reporting & Analytics: Build RaaS solutions, create dashboards, and generate reports to track key HR metrics and analyze data for decision-making.

• Answering phone calls and responding to inquiries from patients/residents, outlying facilities or providers about healthcare programs and services or request of transferring patients into a facility. • Depending on the department, may provide support to RN or physician staff or receiving and dispatching correspondence for designated unit. • Assisting with administrative tasks, such as ordering supplies and scheduling. • Collaborating to create and maintain a clean environment within healthcare facilities. • Depending on department, direct patient contact will vary. Primary duties will vary by department.

Role Description The Revenue Management Educator is accountable for the successful development, implementation, and delivery of educational and training resource materials to assist providers in coding accuracy. The Educator develops and implements strategic action, quality improvement, and risk management plans. The Educator provides overall educational support and coding quality assurance activities to both internal and external stakeholders as it relates to Medicare Advantage, ACA/Exchange, and Medicaid risk adjustment reimbursement methodologies and policies to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS). - Develops educational materials for providers in relation to diagnostic coding and risk adjustment revenue management. - Identifies inadequate or erroneous documentation and/or coding to determine process improvement and educational opportunities. - Researches appropriate material (terminology, testing, abbreviations) to accurately assess documentation. - Analyzes coding and documentation to make appropriate judgments based on coding guidelines and policies. - Monitors and audits performance in areas of compliance risk ensuring that established policies and procedures are being followed. - Identifies the root cause of any errors to determine process improvement opportunities that may result in training, reference material revisions, and process changes. - Assists in audits related to risk adjustment revenue management to address clinical issues related to documentation and coding. - Assesses health insurance products, compliance, or operational risks and develops risk management strategies to improve revenue and reduce audit risk. - Reviews, interprets, and disseminates information relating to pending industry changes, trends, and best practices to include CMS and DHS guidelines related to revenue management. Qualifications - Bachelor’s degree required with an emphasis in a business or medical field, or a registered nurse degree. - Completion of courses in Current Procedural Terminology (CPT), ICD‐9, ICD-10, and Hierarchical Condition Category (HCC) coding required. - Bachelor of Science in Nursing preferred. - Three years’ experience required in a health insurance, nursing, compliance, or auditing related position. - Knowledge of CPT coding rules, ICD‐9 and ICD‐10 codes, Healthcare Common Procedure Coding System (HCPCS) codes, HCC coding, use of modifiers, documentation guidelines, CMS Policy requirements, and other reimbursement guidelines. - Demonstrated knowledge of anatomy/physiology, medical terminology, Word, Excel, PowerPoint, and Access. - Adult education/training and curriculum development preferred. - Certified Professional Coder certification awarded by American Academy of Professional Coders required within one year. - State of Wisconsin Registered Nurse license (if applicable). - Certified Risk Adjustment Coder awarded by American Academy of Professional Coders preferred. Company Description Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.

Role Description The Claims Auditor is responsible for performing payment, procedural accuracy, turnaround time, compliance and operational audits on claims as directed by management. The Claims Auditor has working knowledge of the overall aspects of claim processing. Responsibilities include applying effective, appropriate and efficient audit procedures in collecting, analyzing and reporting concise and relevant findings. - Develops and maintains a knowledge base of: - CPT coding guidelines - ICD codes - Healthcare common procedure coding system (HCPCS) codes - Use of modifiers - Documentation guidelines - CMS policy - Medicaid rules - Other reimbursement guidelines - Reviews claims for accuracy, compliance, proper billing and ensures adherence to insurance policies and regulations. - Utilizes plan documents to ensure appropriate claim benefit application and coverage. - Develops and maintains thorough knowledge of the Audit application and claims processing systems. - Conducts monthly audits of pre-pay and post-paid claims to verify accuracy of processing, financial, procedural and turnaround time. - Investigates and reports claim variances to the appropriate staff for correction. - Conducts focused or ad-hoc audits, as determined by business needs. - Reviews medical records to determine the appropriateness of medical charges on claims chosen for complex audit review. - Analyzes and resolves complex claim processing problems to ensure timely resolution of questions, audits or system issues. - Analyzes claim errors and provides reports to management to improve processes, editing or claim workflows. - Other duties as assigned. Qualifications - High school diploma or equivalent required. - Successful completion of the following courses per departmental procedures, within one year of hire required: - Current procedural terminology (CPT) - Current international classification of diseases (ICD) - Health care procedure coding system (HCPCS) - Medical terminology - Associates degree in business, medical or related field preferred. - Three years of experience related to health insurance claim processing required. - Three years of experience related to CPT/HCPCS and current ICD coding. - Demonstrated proficiency with analytical problem solving, written and oral communications and the Microsoft Office Suite. - Working knowledge of anatomy & physiology. - One year experience in claims auditing preferred. - Certified Professional Coder (CPC) or Certified Professional Coder – Payer (CPC-P) certification awarded by the American Academy of Professional Coders (AAPC) at time of hire preferred. Requirements - Fully remote job. - Flexible scheduling options available. Benefits - Salary Range: $17.50 - $28.00 - Union Position: No Company Description Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.

Role Description This position is responsible for the accuracy, completeness, and required regulatory filings of the Health Plan’s (HP) provider network. Serves as a resource for strategic planning, compliance, and network analysis. Responsible for completion of network adequacy filings for Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), Department of Health Services (DHS), and requested employer groups. Accountable for the maintenance, enhancements, and overall data integrity to ensure the Health Plan’s provider directory meets established CMS standards. - Develops and enforces data quality standards within the provider and facility database to ensure that credentialing software is a source for up-to-date accurate record information. - Completes network adequacy reviews, in collaboration with the Health Plan's Business Intelligence Department representatives to include CMS time and distance standards, ensuring HP meets required network standards to expand their service area. - Performs analyses and audits to identify gaps in current provider networks to ensure corrections are made by contracting to maintain compliance with required adequacy standards. - Coordinates required regulatory provider network submissions to ensure HP meets contractual obligations. - Audits and advises provider credentialing on identified data issues, including working with delegated credentialed entities, to ensure that complete and accurate information is being received. - Maintains accurate data in HP Provider Directory to ensure it's in compliance with CMS, DHS, and Office of the Commissioner of Insurance requirements. - Organizes a large amount of data into easy to understand formats to help aid in strategic planning for HP. - Maintains a strong understanding of providers and facilities in current HP's service area and patterns of care to help identify opportunities for potential expansion. - Researches and communicates regulatory directives to ensure HP maintains compliant practices. - Performs disruption analysis for potential customers of HP to identify potential improvements to effectively provide competitiveness for bids. - Other duties as assigned. Qualifications - Bachelor’s Degree in business administration, finance, healthcare related field, computer science, or analytics. - Successful completion of a post-secondary medical terminology course preferred. - Three years’ experience in a medical group practice, health insurance or Health Maintenance Organization (HMO) environment. - Demonstrated knowledge of data manipulation and analytical analysis. - Proficiency with Microsoft Office suite to include products, Excel and Access. - Understanding of geoaccess coding, provider credentialing, and medical terminology preferred. Company Description Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.

Role Description Assigns codes to diagnoses and procedures for outpatient medical records using current International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding classification systems. Coding assignments are made for the purposes of reimbursement, research, compliance with federal and state regulations/guidelines and for severity of illness. - Meet productivity and quality standards. - Requires ongoing review and adherence to a multitude of regulatory requirements that are constantly changing. - Applies professional knowledge and uses critical thinking skills to assign codes to meet various payment groupings and medical necessity. - Works extensively with electronic medical record. Qualifications - Associate's degree in health information technology. - Bachelor's degree in Health Information Management (HIM) preferred. - Extensive knowledge of anatomy, physiology, disease processes and medical terminology. - Familiar with operative terms and pharmacology. - Maintain certification in Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) by fulfilling continuing education requirements. - New graduates eligible for certification must complete the certification examination at the earliest testing dates following employment, and all subsequent dates thereafter until the exam is satisfactorily completed. - If an employee fails the exam two consecutive times, there will be an evaluation by the Department Director who will determine one of the following: - (A) Continue employment if overall job performance is satisfactory. If allowed to continue employment, failure to pass the exam on the third opportunity will result in immediate termination. - (B) If performance is not satisfactory, the employee may be terminated. Requirements - Prior coding classification education required. - Previous hospital coding experience highly desirable. - Prior computer and/or encoder software experience desirable. - Work requires extreme attention to detail and work which meets high ethical standards. - Logical thinking and the ability to acquire an intricate knowledge of system software and hardware. - Knowledge of components of the medical record. - Extensive knowledge of anatomy, physiology, disease processes and medical terminology. - Familiar with operative terms and pharmacology. - Work extensively with protected health information and is required to adhere to HIPAA privacy and security regulations and policies related to same. Benefits - Flexible hours- so our employees can get personal tasks done at their leisure. - Variety of hours per day to select from: five 8 hrs, four 9hrs + one 4hr, or four 10’s. - Multiple specialty coding- so the coder can learn a vast majority of areas. - Working remotely in the comfort of your own home. - Optional overtime approved frequently. Company Description Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.

• Provides temporary nursing facility leadership and support • Monitors the operations of the nursing staff and ensures compliance with regulations • Schedules staff and conducts employee performance reviews • Maintains communication and addresses the rapidly changing healthcare environment

• Review medical documentation and assign appropriate codes (ICD-10, HCPCS, CPT). • Ensure compliance with coding standards, regulations, and company procedures. • Communicate effectively with medical professionals to improve documentation accuracy. • Participate in coding team meetings and serve as a subject matter expert. • Validate physician charge capture and conduct appeals management related to coding.