• Analyzes medical information from medical records • Accurately codes diagnostic and procedural information in accordance with national coding guidelines • Consults with medical providers to clarify missing or inadequate record information • Provides thorough, timely and accurate coding in accordance to department specific productivity and quality standards • Abstracts clinical diagnoses, procedure codes and documents other pertinent information obtained from the medical record • Ensures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, CMS, OIG, and HCFA • Compiles daily and monthly reports; tabulates data from medical records for research or analysis purposes • Works independently under regular supervision

Department: 13376 Enterprise Revenue Cycle - Individualized Clinician Services Primary Care and Medical Specialties Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Remote position. 1st Shift CST Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY Pay Range $35.50 - $53.25 Major Responsibilities: - Deliver proactive coding education through newsletters, scorecards, and presentations, covering CPT (E&M, modifiers), ICD-10-CM, HCPCS, Risk Adjustment, payer requirements, and rejection resolutions. - Lead onboarding and compliance training for all employed Physicians/APPs, including Locum Tenens, residents, and students, ensuring documentation accuracy from the start. - Provide individualized documentation feedback by reviewing new clinician records and conducting spot checks, escalating non-coding issues to appropriate teams. - Serve as the primary contact for coding inquiries, coordinating with internal teams to resolve complex issues such as NCCI bundling and high-complexity charge edits. - Monitor Epic work queues (charge review, follow-up, claim edit) to ensure timely and accurate charge submissions and reduce claim denials. - Collaborate across departments—including CMOs, Clinical Informatics, Risk Adjustment, and Population Health—to enhance documentation practices and system optimization. - Participate in specialty and department meetings, identifying trends and delivering targeted education to improve coding and documentation accuracy. - Refine Epic documentation tools, including templates, order entries, diagnosis lists, and SmartSets/SmartPhrases, to improve efficiency and accuracy. - Ensure compliance with regulatory standards, including Medicare, Medicaid, and AHIMA’s Standards of Ethical Coding, while maintaining expert knowledge of evolving policies. - Promote a culture of ethical coding and continuous improvement, supporting clinicians with timely updates, feedback, and education to ensure accurate reimbursement and compliance. Licensure, Registration, and/or Certification Required: - Registered Health Information Administrator (RHIA) or - Registered Health Information Technician (RHIT) certification, or - Coding Specialist (CCS) certification, or - Coding Specialist – Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA) or - Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC). - Additional specialty credential preferred. Education Required: - Completion of advanced training through a recognized or accredited program, equivalent in scope and rigor to post-secondary education or equivalent knowledge. High school diploma or GED required. Experience Required: - Typically requires 4 years of experience in expert-level professional coding. Knowledge, Skills & Abilities Required: - Advanced Coding Expertise: In-depth knowledge of ICD, CPT, and HCPCS coding guidelines, ensuring accurate and compliant coding practices. - Medical Terminology & Anatomy: Strong understanding of medical terminology, anatomy, and physiology to support precise code assignment. - Epic & Reporting Solutions: Advanced knowledge of Epic and other reporting tools to analyze data, generate reports, and optimize workflow efficiencies. - Critical Thinking & Analytical Skills: Highly proficient in problem-solving and analytical thinking with strong attention to detail. - Interpersonal Communication: Excellent verbal and written communication skills, with the ability to educate and collaborate effectively with physicians, APCs, clinical leadership, and coding teams. - Advanced Computer Skills: Proficiency in Microsoft Office Suite, electronic coding applications, and email communication. - Organizational & Prioritization Skills: Ability to efficiently manage multiple tasks, set priorities, and meet deadlines in a fast-paced environment. - Independent Decision-Making: Ability to work independently, exercise sound judgment, and make informed decisions regarding coding and compliance. - Collaboration & Initiative: Strong ability to take initiative, contribute to process improvements, and work collaboratively within a team environment. Physical Requirements and Working Conditions: - Follow organizational and divisional remote work policy and guidelines. - Operates all equipment necessary to perform the job. - Handles a fast paced and creative work environment moving independently from one task to another. - Makes sound decisions within limited time frames and always conducts business in a professional manner and has demonstrates ability to work cooperatively and effectively with others on an individual and team basis. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. #REMOTE #LI-REMOTE Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation - Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training - Premium pay such as shift, on call, and more based on a teammate's job - Incentive pay for select positions - Opportunity for annual increases based on performance Benefits and more - Paid Time Off programs - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability - Flexible Spending Accounts for eligible health care and dependent care expenses - Family benefits such as adoption assistance and paid parental leave - Defined contribution retirement plans with employer match and other financial wellness programs - Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Job DetailsJob Location: Polaris Pharmacy Services of Ft Lauderdale - Ft. Lauderdale, FL 33309Position Type: Full TimeJob Category: PharmaceuticalPRIOR AUTHORIZATION SPECIALIST (REMOTE) WHO WE ARE At Polaris Pharmacy Services, we’re more than a pharmacy — we’re a dedicated partner in care, transforming how patients experience long-term, post-acute, correctional, PACE, and specialty pharmacy services. As industry leaders, we’re raising the bar for quality and coordination across all sites of care, ensuring every patient receives seamless, compassionate, and expert support. Founded in 2015, Polaris is proud to be locally and independently owned, with a growing national footprint. Our team thrives in a mission-driven environment where innovation meets purpose, and every role contributes to making a real impact. We offer more than just a job — we provide competitive pay, robust benefits, and genuine opportunities for career advancement. If you're passionate about shaping the future of pharmacy and making a difference in the lives of those who need it most, we invite you to grow with us. OVERVIEW The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers. The Prior Authorization Specialist must be responsive and courteous when addressing our customers needs. Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers trust and respect. RESPONSIBILITIES Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement Contact providers and/or customers as necessary to obtain additional information Monitor and resolve revenue at risk associated with payer set up, billing, rebilling, and reversal processes Work as a team to identify, document, communicate, and resolve payer/billing trends and issues Complete, communicate, and submit necessary payer paperwork, including but not limited to prior authorizations forms and manual billing in a timely manner Review and work convert billing exception reports to ensure claims are billed to accurate financial plans Complete billing transactions for non-standard order entry situations as required Support training needs Prepare and maintain reports and records for processing Perform other tasks as assigned. Follow all applicable government regulations, including HIPAA Comply with departmental policies regarding safety, attendance, and dress code Overtime, holidays, and weekends may be required and/or expected Conduct job responsibilities in accordance with the standards set out in the Companys Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards Other duties as assigned; Job duties may vary depending on business needs QualificationsQUALIFICATIONS High School diploma or equivalent required Minimum of one (1) or more years working as a pharmacy technician in a retail environment required (long-term care pharmacy preferred) Framework LTC & General computer knowledge & 10-key Number Entry preferred Able to read, write, speak, and understand the English language Able to retain a large amount of information and apply that knowledge to related situations Able to work in a fast-paced environment Basic computer knowledge skills required Basic math and analytical skills Experience with alpha-numeric data entry Proficient in Microsoft Word, Excel, and Outlook required Customer Service Results-oriented Good organization/Attention to detail Reliable Problem solver Able to work various shifts and days Adaptability to an ever-changing environment PHYSICAL DEMANDS The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job: May sit or stand seven (7) to ten (10) hours per day The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently May be necessary to work extended hours as needed May lift and/or move up to 50 pounds The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role HOLIDAY & PTO POLICY Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days. Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses. Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility. Please note we are a long-term care pharmacy open 24-hours a day, 7 days a week. And schedules may change as determined by the needs of the business. BENEFITS for full time employees Medical, Dental, and Vision insurance 401 (k) (available for Part Time & Full Time EEs) Company Paid Life insurance Short-term and Long-term disability insurance Tuition reimbursement Personal Time Off (PTO) Competitive pay with annual performance reviews and merit-based raises Career growth potential Annual on-site voluntary Flu Vaccine Employee referral bonus program

Grow your career at Cedars-Sinai! Cedars-Sinai placed in the top 20 on Newsweek’s “World's Best Smart Hospitals 2024” list, which highlights hospitals that have excelled in the utilization of electronic functionalities, telemedicine, digital imaging, artificial intelligence and robotics. The organization’s Healthtech excellence was acknowledged again, this time by the esteemed “CHIME Digital Health Most Wired“ recognition program. Cedars-Sinai was assigned a Level 10—the most prestigious level of certification—among more than 300 surveyed healthcare organizations. Cedars-Sinai netted high scores across multiple verticals and particularly excelled in areas of infrastructure, interoperability, and population health innovation. Why work here? Beyond an outstanding benefit package and competitive salaries, we take pride in hiring the best, most committed employees. Our staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a multifaceted, inclusive environment that fuels innovation and the gold standard of patient care we strive for. What will you be doing: The PB (Professional Billing) Analyst independently provides an intermediate level of operational and application build expertise in completing routine and occasionally more sophisticated assignments to meet customer goals and desired outcomes. Task and assignment focus is typically on medium to large projects, performing workflow analysis, build, and documentation in collaboration with internal and external team members. - Performs intermediate level design, build and implementation assignments/ projects. Based on core knowledge of the PB application and operational requirements can translate requirement/concepts into functionality. - Assigned to various work/projects and demonstrates an ability to successfully complete assigned tasks/assignments, proactively connect with manager to prioritize workflow and mitigate risks, track issues and provide solution-oriented partner concern, and understand project management methodologies. - Participates in re-engineering of operational work-flow processes with end-users/business owners and maintains working level understanding of assigned departmental operations. - Facilitates end-user/business owner needs into system specifications and configuration requirements. - Maintains high standards for quality application design, build, testing, and other tasks; ensures adequate documentation is provided for support and end-user training. Manage and coordinate intermediate to advanced configuration and build assignments/projects in collaboration with others. *Approved Remote States: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas*