Anne Arundel Medical Center Title: Coordinator, Pre-Authorization Verification & Eligibility (PAVE) Department: PAVE Reports To: Supervisor - PAVE Cost Center/Job Code: 10000-50133-000723 FLSA Status: Non - Exempt Position Objective: The PAVE Coordinator is responsible for initiating Pre-Authorization request to the payer for the claims that require approval. This position require communication with payers, patients, physician offices and hospital clinical staff. This position is primarily responsible for pre-certifying procedures ordered by physicians. The PAVE Coordinator will also be responsible monitoring appropriateness and medical necessity and provides necessary information for authorization and continued visits. This individual will confirm pre-certifications that have been obtained or will obtain pre-certifications if needed in addition to conducting quality assurance. Essential Job Duties: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - Serve as primary resource for LH regarding insurance eligibility; prior authorization process and requirements; collects patient demographic information and coverage information. Advises patients of their financial obligation and collects payments in a courteous and professional manner. - Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information; - Updates systems with accurate information obtained; performs quality assurance audits and reports back to leadership opportunities for providing education to patient access - Responsible for communicating to service line partners of situations where rescheduling is necessary, due to lack of authorization or limited benefits and is approved by clinical personnel; - Ensures that proper authorization is in place for inpatient, elective, outpatient, surgical, urgent/emergent services and held responsible for timely notification to payers of the patient’s visit to the facility to protect financial standing of the organization. Escalates non-authorized accounts/visits to management; - Ensures all benefits (Copays, Deductibles, Co-Insurance, OOP, LTM), authorizations, pre-certifications, and financial obligations of patients, are documented on account, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts and denial prevention.; - Maintains a close working relationship with clinical partners, and ancillary departments to ensure continual open communication between clinical, ancillary, and Patient Access & Patient Financial Services, Surgical Scheduling departments. Case Management, and Utilization Review to facilitate the sending of clinical information in support of the authorization to the payer, as assigned; - Monitors team mailbox, e-mail inbox, faxes, and phone calls responding to all related PAVE account issues, within defined time frames; Adheres to the department accuracy and performance standards. - Contact payer to obtain prior authorization. Gather additional clinical and or coding information, as necessary, in order to obtain prior authorization; 10. Provide standardized documentation within system to identify prior authorization and the criteria surrounding such authorization; Verify that all insurance requirements have been met; Notify patient, Provider’s Office, Scheduling and Financial Counselor immediately when insurance coverage is inadequate or has been terminated. 11. Advises providers and their clinical staff when issues arise relating to obtaining prior authorization; educate providers and their clinical staff regarding the prior authorization process. 12. Stay informed and research information regarding insurance criteria for prior authorization; Attend department staff meetings, professional education sessions, complete e-learnings and mandatory training. 13. Performs other duties as assigned by PAVE Leadership. Educational/Experience Requirements: - Minimum two (2+) years of experience in Medical Billing, Hospital Patient Access, or Hospital Business Office in an automated setting. - Knowledge of registration, verification, pre-certification, and scheduling procedures. - Experience with Medical and Insurance terminology (ICD-10, CPT 4) - Minimum of one (1+) year of demonstrated strong analytical skills - Proficiency with Microsoft Office and Outlook - Excellent verbal and written communication skills. - Preferred experience with the Epic Hospital Billing System - Associates Degree Accounting, Finance, Business Administration or Healthcare related field preferred - Minimum two (2+) years of Revenue Cycle Experience in lieu of degree Required License/Certifications: - 1 or more Certifications preferred: - CRCE - Certified Revenue Cycle Executive - CRCP- Certified Revenue Cycle Professional - CRCS- Certified Revenue Cycle Specialist - CHAM – Certified Healthcare Access Manager - CHAA- Certified Healthcare Access Associate - CHFP- Certified Healthcare Financial Professional - CRCR- Certified Revenue Cycle Representative Working Conditions, Equipment, Physical Demands: There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens. Physical Demands - The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act. The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary. Pay Range $17.50—$26 USD Luminis Health Benefits Overview: • Medical, Dental, and Vision Insurance • Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year) • Paid Time Off • Tuition Assistance Benefits • Employee Referral Bonus Program • Paid Holidays, Disability, and Life/AD&D for full-time employees • Wellness Programs • Employee Assistance Programs and more *Benefit offerings based on employment status Opt-in for text notifications! Luminis Health's two-way SMS texting platform lets you receive notifications and messages from our Talent Acquisition team directly on your phone. To enable this feature, select "yes" when asked to "opt-in to receive text messages" and to "Receive updates from a recruiter about this job via SMS" when completing your application. Once you are opted in, you can easily opt-out at any time. Standard text messaging rates may apply based on the candidate's mobile carrier plan. 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This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Billing Integrity Manager is responsible for overseeing the accuracy, compliance, and overall quality of the organization’s billing processes. This role ensures that claims are submitted correctly, payer guidelines are followed, and revenue cycle workflows maintain the highest level of integrity and efficiency. The Billing Integrity Manager works closely with billing teams, coding specialists, and operations leadership to: - Identify errors - Improve processes - Reduce denials - Maintain compliance with payer and regulatory requirements Qualifications - Bachelor’s degree in Healthcare Administration, Business, Finance, or related field preferred - 5+ years of experience in medical billing, revenue cycle management, or healthcare finance - 2+ years of leadership or supervisory experience preferred - Strong knowledge of: - Medical billing processes - Claims submission and denial management - Insurance payer guidelines - Revenue cycle workflows - Experience with EHR/EMR and billing systems - Strong analytical and problem-solving skills - Ability to identify trends and implement process improvements Requirements - Experience with neurology, behavioral health, or specialty care billing preferred - Certifications such as: - CPB (Certified Professional Biller) - CPC (Certified Professional Coder) - CRCR (Certified Revenue Cycle Representative) Benefits - Competitive salary - Remote work environment - Opportunities for growth within the revenue cycle leadership team - Continuing education and professional development support

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This is a remote position to candidates within the UnityPoint Health geographical blueprint. Shift: Monday - Friday | 8:00 AM - 5:00 PM Ensures accurate and compliant billing for patient accounts and rental equipment by thoroughly reviewing documentation and account details on an ongoing basis. Serves as a quality assurance resource for the Home Medical Equipment Department, helping maintain high standards in billing practices. Manages and verifies all required documentation to support timely and accurate insurance billing for equipment and supplies, contributing to efficient operations and optimal reimbursement. Responsibilities - Reviews all paperwork for accuracy, noting any missing or incomplete data and forwarding to appropriate person for completion when necessary. - Confirms delivery tickets on a daily basis. Tickets must be entered into system on a timely, consistent manner to allow for prompt payments after money is booked to the system. - Works the Billing Review queue on a daily basis. - Reviews all documentation to identify any qualification issues. - Communicates identified problems to appropriate staff to assure follow up is completed to expedite claims and ensure timely and accurate payment. Qualifications - High school or vocational school graduate or an equivalent combination of education and experience. - Strong interpersonal skills. - Strong verbal and written communication skills. - Ability to work as a collaborative team member. - Ability to understand and apply guidelines, policies and procedures. - Use of usual and customary equipment used to perform essential functions of the position. Benefits - Paid time off, parental leave, 401K matching and an employee recognition program. - Dental and health insurance, paid holidays, short and long-term disability and more. - Pet insurance for your four-legged family members. - Early access to earned wages with Daily Pay. - Tuition reimbursement to help further your career. - Adoption assistance to help you grow your family. Company Description At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members. With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together. We believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Assign appropriate codes for all patient types and provider clinics, including consulting with physicians and clinical staff for appropriate coding of difficult cases and code assignments. This position is PRN or as needed. Eligible for 16% PRN Differential. - Attention to Detail: Verifies patient information to identify any documentation vs. report discrepancies and ensures codes and other abstracted data are accurately applied to appropriate patient’s account/encounter. - Coding and Abstracting: Primarily codes outpatient encounters. Applies codes to conditions and procedures documented in the medical records to provide information for financial reimbursement and data collection, converts interpreted data into appropriate code numbers. - Quality Control: Recognizes and reports unusual circumstances and/or information with possible risk factors to appropriate risk management and HIM Manager. Reports problems, errors, and discrepancies in dictation and patient records to HIM Manager. While reviewing the record for coding purposes, serves as quality reviewer of scanned documents. Identifies mis-scans and poorly scanned documents and reports them to HIM Director. - Quality/Quantity: Meets coding quality and quantity expectations of 95% or higher. - Collaboration: Collaborates with others in the organization including the Quality Department, Medical Staff, other clinicians, and physician office staffs; and with Patient Financial Services to ensure the codes submitted for claims are supported by the documentation in the record. - Communication: Excellent written and oral communication skills and the ability to work independently with minimal supervision required. Legible penmanship required. - Constant Learner: Attends all required in-services and coder meetings. Identifies and attends training and educational programs conducive to professional growth. Utilizes current literature and workshops attended to the benefit of Vail Health. New ideas, policies, regulations, and philosophies are adapted to current policies and procedures appropriately. - Vail Health Supporter: Supports the philosophy, objectives, and goals of VH and the HIM department by volunteering in various capacities without compromising performance expectations. Role models the principles of a Just Culture and VH Values. - HIM Department Supporter: Contributes to the efficiency of the HIM department. Routinely volunteers to assist others when their work is completed. - Ethics: Routinely abides by standards of professional and ethical conduct as defined by CMS, AHIMA, and the professional organization from which the incumbent is certified and/or credentialed. - Compliance: Understands and complies with policies and procedures related to medicolegal matters including confidentiality, amendment of medical records, release of information, patient rights, medical records as legal evidence, informed consent, etc. Is knowledgeable of and complies with Vail Health HIPAA, Safety and Compliance Program Policies and Procedures. - Other Duties: Perform other duties as assigned. Qualifications - One year of experience coding outpatient hospital accounts and/or Profee preferred. Requirements - License(s): N/A - Certification(s): One of the following is required: - Registered Health Information Technician (RHIT) by the American Health Information Management Association (AHIMA) - Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA) - Certified Coding Specialist (CCS) by American Health Information Management Association (AHIMA) - Certified Coding Specialist - Physician-based (CCS-P) by American Health Information Management Association (AHIMA) - Certified Professional Coder (CPC) by American Academy of Professional Coders (AAPC) Benefits - Pay is based upon relevant education and experience per hour. - Hourly Pay: $22.10 — $29.52 USD