Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for validating/reviewing and assigning applicable CPT, ICD-10, Modifiers and HCPCS codes for inpatient, outpatient and physicians office/clinic settings. Adheres to all coding and compliance guidelines. Maintains knowledge of coding/billing updates and payer specific coding guidelines for multi-specialty medical practice(s). Communicates with providers and team members regarding coding issues. Essential Functions - All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference. - Validates/reviews codes for assigned provider(s)/Division(s) based on medical record documentation. Adheres to all coding and compliance guidelines. - Responsible for resolving all assigned pre-billing edits - Communicates billing related issues and participates in meetings to improve overall billing process - Provides feedback to providers in order to clarify and resolve coding concerns. - Assists in identifying areas that need additional training. - Performs other duties as assigned. Supervisory/Management Responsibilities - This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements - Education - High School diploma or equivalent or post-high school diploma / highest degree earned. Associate degree preferred - Experience - Two (2) years professional coding experience In Lieu Of - NA Required Certifications, Registrations, Licenses - Certified Professional Coder-CPC Knowledge, Skills and Abilities - Maintains knowledge of governmental and commercial payer guidelines. - Participates in coding educational opportunities (webinars, in house training, etc.). - Ability to utilizes appropriate coding software and coding resources in order to determine correct codes. - Proficient computer skills including word processing, spreadsheets, database - Data entry skills - Mathematical skills Work Shift Day (United States of America) Location Independence Pointe Facility 7001 Corporate Department 70019178 Medical Group Coding & Education Services Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

• Review/Analyze explanation of benefits (EOB), Remittance Advice, and Denials from Payers to drive resolution for account receivables. • Preparation and analysis of aging reports. • Use all channels available to resolve and collect account receivables with payers which includes but is not limited to utilizing payer portals and outbound calls to the provider desk. • Review or update claims corrections and uploads required documents in our clearinghouse portals. • Identifying underpayments and preparing documents for appeals. • Creating batches and post-received payments. • Code claims accordingly with CPT and ICD 10s codes. • Perform other duties assigned by the management. • Post charges to create a claim and submit it to our clearinghouses. • Contact patients, providers, and payers to check eligibility, pre-cert, or follow up on claims/appeals. • Ability to work well independently and communicate efficiently and respectfully with patients and insurance representatives. • Identify billing errors and denials, by understanding the problem and resubmit corrected claims or take other appropriate action to resolution.

• Provide appropriate coding on client’s treatment plans and tests • Enter and code patient services into a computer system • Generate invoices to insurance companies and clients • Maintain strict client confidentiality

Work From Home Work From Home Work From Home, Indiana 46544 The Prior Authorization Specialist is responsible for obtaining prior authorization for provider practices which may include outpatient services, specialty care and other ancillary services. The Prior Authorization Specialist verifies insurance coverage and gathers clinical information to ensure that all reimbursement requirements are met. The ability to Compassionately engage in conversation with patients on their responsibilities for Copayment, Prepayment and Outstanding Balances. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT - Follows payer processes (website, fax, contact number) to submit appropriate clinical documentation; remains current on updates from payers to ensure appropriate reimbursement from payers. - Serves as primary resource to ambulatory clinics regarding the prior authorization process and requirements. - Collects clinical information regarding services to be rendered for prior authorizations. - Contacts payers to obtain prior authorizations; enters standardized documentation within electronic medical record, to identify prior authorization and the criteria surrounding each authorization. - Educates providers and their clinical staff regarding the prior authorization process; advises providers and their clinical staff when issues arise relating to obtaining prior authorization. - Primary resource to patients regarding prior authorization process. - Verifies that all insurance requirements have been met. QUALIFICATIONS - Required High School Diploma/GED - 1 year Prior Authorizations and Revenue Cycle Required TRAVEL IS REQUIRED: Never or Rarely JOB RANGE: Prior Authorization Specialist $18.55-$24.12 INCENTIVE: Not Applicable EQUAL OPPORTUNITY EMPLOYER It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity. Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.