This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Specialty Admission Coordinator is responsible for managing specialty medication referrals from receipt through insurance clearance to ensure timely and accurate patient access to therapy. This role serves as the key point of contact for benefit investigation, prior authorization, coordination with internal stakeholders (pharmacy and nursing staff) and financial counseling with patients. The coordinator plays a critical role in ensuring referrals meet payer requirements and in facilitating seamless communication between patients, providers, pharmacy staff and the sales team. This is a remote position. Monday-Friday 8:30am-5:30pm (MST or PST) Responsibilities - Owns and manages the specialty referral from initial intake through insurance approval - Conducts timely and accurate benefit investigation, verifying both medical and pharmacy benefits - Identifies and confirms coverage criteria, co-pays, deductibles and prior authorization requirements - Prepares and submits prior authorization requests to appropriate payers - Maintains clear, timely communication with pharmacy teams, sales representatives and prescribers regarding the status of each referral and any outstanding information - Coordinates and delivers financial counseling to patients, including explanation of out-of-pocket costs, financial assistance options and next steps - Ensures all documentation complies with payer and regulatory requirements - Updates referral records in real-time within computer system - Collaborates with patient services and RCM teams to support a smooth transition to fulfillment - Tracks and reports referral statuses, turnaround times and resolution outcomes to support process improvement Supervisory Responsibility: No Qualifications - High school diploma or GED required; Associate’s or Bachelor’s degree preferred. - Minimum of 2 years of experience in a healthcare, specialty pharmacy, or insurance verification role. - Experience working with specialty medications, including benefit verification and prior authorization processes. - Experience in patient-facing roles is a plus, especially involving financial or benefit discussion. - Familiarity with payer portals. - Strong understanding of commercial, Medicare, and Medicaid insurance plans. - Proven track record of communicating effectively with internal and external stakeholders. - Desired: Experience in Microsoft BI. Experience in Outlook, Word, and PowerPoint. Requirements - Percentage of Travel: 0-25% - To perform this role will require constant sitting and typing on a keyboard with fingers, and occasional standing, and walking. - The physical requirements will be the ability to push/pull and lift/carry 1-10 lbs. Company Description Amerita, an affiliate of BrightSpring Health Services, is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness, and entrepreneurial spirit of a local provider. For more information, please visit www.ameritaiv.com . Follow us on Facebook , LinkedIn , and X . Salary Range USD $21.00 - $29.00 / Hour

• Review medical bills submitted by insurance companies related to MVA injuries sustained for NJ and or NY-covered insureds • Interpret medical documentation ensure accuracy of billed services IE: CPT, HCPCs codes • Assign proper CPT, HCPCs codes based on the review outcome • Review CPT codes for unbundled services • Review billed modifiers for accuracy of use • Crosswalk CPT codes per regulatory requirements to ensure correct reimbursement • Interpret fee schedule guidelines and apply those guidelines in daily reviews • Document review outcomes for customers in a professional easy to understand manner • Use various resources, IE: eBooks, 3M software to support reviews • Participate in conference calls as needed with customers and/or attorneys • Participate in virtual and in-person testimony or trial when needed • Assist with various special projects and 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 SAIC is looking for a Full-Time Remote Medical Coder III to provide remote medical coding support to government Medical Treatment Facilities assigned under the Defense Health Agency (DHA) Medical Coding Program Branch. - Experience in multiple coding modalities/specialties, such as: - Inpatient professional - Inpatient facility - Same day surgeries - Observation - Emergency Department - Outpatient specialty/primary care encounters Qualifications - A minimum of five (5) years of medical coding and/or auditing experience in four or more medical, surgical, and ancillary specialties within the past fifteen (15) years. - A minimum of one (1) year of performance in the specialty is required to be qualifying. - Multiple specialties encompass different medical specialties (i.e., Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS codes. - Ancillary specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience. - Coding, auditing, and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience. - Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor. Requirements - Applicants must have ONE of the following medical coding certifications: RHIT/RHIA/CPC/CCS-P/CEMC/CEMA/CCS/CIC. - Applicants who possess multiple certifications from the list above are preferred. - Medical coding personnel shall maintain the required continuing education hours in order to maintain current and proper national certification (requirements for this position). - Selected applicant must do the following before starting, based on government requirements: - Pass a pre-employment coding test - Provide proof of specific vaccinations - Be subject to a government security investigation and must meet eligibility requirements - Must be a US Citizen.

• Perform detailed medical coding audits (ICD-10-CM, CPT, HCPCS) • Conduct utilization reviews to determine medical necessity and documentation compliance • Review and prepare demand packages and audit response materials • Analyze records for payer disputes and recoupments • Prepare written audit findings and defensible reports • Provide expert support for depositions and testimony as needed • Review E/M services under 2021+ guidelines • Interpret CMS, LCD/NCD, and payer-specific policies • Identify risk areas and compliance vulnerabilities