This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Risk Adjustment PB Coder reviews, analyzes, validates and assigns codes from Mayo Clinic’s patient medical record for physician services in the outpatient or inpatient setting to include, but not limited to: - Medical diagnosis - Diagnostic services - Procedural services - E/M visits level coding information for various practices A Risk Adjustment Coder is responsible for: - Reviewing physician and other provider’s medical record notes and visit documentation - Selecting or validating appropriate ICD-10-CM diagnosis codes - Selecting appropriate CPT-4 codes for CMS-1500 claim submissions The primary focus of this role is diagnosis assignment related to risk adjustment payment methodology, which may influence provider cost and quality indicators. Benefits - Medical: Multiple plan options. - Dental: Delta Dental or reimbursement account for flexible coverage. - Vision: Affordable plan with national network. - Pre-Tax Savings: HSA and FSAs for eligible expenses. - Retirement: Competitive retirement package to secure your future. Company Description Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic. Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in: - Phoenix/Scottsdale, Arizona - Jacksonville, Florida - Rochester, Minnesota And at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.

Prior Authorization Specialist (Remote – Select States Only) TRA Medical Imaging Remote | Full-Time | Monday–Friday | $19.27–$22.93 per hour Applicants must reside in one of the following states to be considered: Alabama, Arizona, Georgia, Idaho, North Carolina, Texas, Utah, or Washington. TRA Medical Imaging is seeking an experienced Prior Authorization Specialist with strong knowledge of radiology procedures, insurance verification, CPT coding, ICD-10 coding, and medical insurance authorizations. This fully remote role supports our radiology practice by ensuring all scheduled imaging exams are authorized, medically necessary, and compliant with insurance carrier requirements. The ideal candidate has at least three years of medical office insurance authorization experience and thrives in a fast-paced healthcare environment. Compensation and Benefits Hourly Pay: $19.27 – $22.93 (based on experience, skills, and qualifications) Benefits Include: - No nights, weekends, or on-call shifts - Medical, Dental, and Vision Insurance - HSA and FSA options - Employee Assistance Program (EAP) - Basic Life Insurance and Long-Term Disability - 401(k) with automatic 3% employer contribution plus up to 3% employer match - 17 days of PTO - 9 paid holidays - Annual automatic compensation growth path - Profit sharing - Optional Pet Insurance, Legal, and ID Protection About TRA Medical Imaging TRA Medical Imaging is a physician-owned and physician-led radiology practice serving the South Puget Sound region for over 100 years. With approximately 100 subspecialized radiologists, TRA is committed to delivering high-quality, patient-centered imaging services while fostering a collaborative, high-trust culture rooted in Compassionate Care, Accountability and Integrity, Respect, and Excellent Service. Position Overview The Prior Authorization Specialist is responsible for ensuring all scheduled imaging examinations: - Are authorized for the correct facility - Include accurate CPT and ICD-10 codes - Meet medical necessity guidelines - Comply with insurance carrier and HIPAA requirements This role works under established guidelines and immediate supervision within Health Information Management, Patient Access, and Scheduling functions Key Responsibilities - Obtain prior authorizations for imaging procedures including MRI, CT, PET, Nuclear Medicine, Fluoroscopy, Interventional Radiology, Mammography, Ultrasound, X-ray, and Bone Densitometry - Verify insurance eligibility, benefits, and authorization requirements - Ensure correct CPT and ICD-10 coding for all scheduled exams - Contact referring physician offices and insurance carriers to obtain required documentation - Review medical records to confirm medical necessity - Enter authorization numbers and detailed documentation into the RIS system - Educate patients on insurance and authorization requirements - Reschedule patients when authorization is pending - Provide price quotes and explain financial assistance options - Maintain HIPAA compliance and patient confidentiality - Collaborate with technologists, front desk staff, and scheduling teams to ensure exam accuracy Required Qualifications - High School Diploma or GED - Formal medical terminology training or equivalent medical office experience - Minimum 3 years of medical office insurance authorization experience - Knowledge of CPT and ICD-10 coding - Experience navigating insurance websites for eligibility and claim status - Understanding of radiology procedures and authorization workflows - Strong attention to detail and ability to manage multiple tasks - Effective written and verbal communication skills - Professional customer service skills Preferred Qualifications - Clinical experience in a radiology or imaging setting - Experience working with RIS systems - Experience with PET scan authorization processes - Knowledge of HCPCS coding Work Environment and Schedule - Fully remote position (training and equipment provided) - Monday through Friday, 9:00 AM – 5:30 PM Pacific Time Ideal Candidate Profile The ideal candidate is detail-oriented, experienced in radiology prior authorizations, comfortable working independently in a remote environment, knowledgeable about insurance carriers and medical necessity criteria, and committed to patient-focused service. Apply Today If you reside in Alabama, Arizona, Georgia, Idaho, North Carolina, Texas, Utah, or Washington and have strong experience in radiology prior authorization, insurance verification, and CPT/ICD-10 coding, we encourage you to apply. Join a respected, physician-led organization with over 100 years of excellence in medical imaging and become part of the next chapter of the TRA story.

Company Description Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers Job Description The RCM Training and Workflow Associate delivers comprehensive virtual athenaOne Collector/Billing training to Care Centers during implementation and post live. This role involves triaging stakeholder issues and requests, and ensuring athenaOne collector training aligns with best practices. The associate maintains current knowledge of new features in athenaOne’s Collector, Clinicals, and Communicator products to optimize workflows for Privia Medical Group Care Centers. The RCM Training and Workflow Associate actively seeks feedback to continually elevate Privia’s RCM and training program to a best-in-class standard. Job responsibilities: - Lead pre-live and post-live athenaOne Collector/billing training to providers, administrative and billing staff in all markets - Ensures that training is scheduled and delivered on-time - Innovate and create new learning experiences for Care Centers for Privia University (LMS). - Provide onsite Go-Live support for New Market and/or high-profile Care Centers - Offer supplemental training opportunities applicable to all markets. - Works collaboratively with cross functional teams to accomplish goals - Share and effectively communicate new athenaOne features regularly - Provides excellent customer service through creative problem solving and follow through - Other duties as assigned Qualifications - Experience with Revenue Cycle Management and Physician office billing required - 2+ years experience with client facing training preferred - 2+ years experience with practice management systems, one or multiple areas of expertise preferred - Experience with athenaOne’s Clinicals and Collector software preferred - Bachelor’s degree preferred - Demonstrated experience in development and editing instructional material - Knowledgeable about extended medical terminology - Must demonstrate excellent communication, organizational, and time management skills - Must demonstrate strong interpersonal skills to interact positively and productively with a variety of personnel within teams and across organizational lines - Ability to work in a very fast-paced and changing work environment - Must comply with HIPAA rules and regulations - Collaborative, customer-focused and able to create visible value. - Team approach to working with others, ability to perform a variety of duties within any work-day and organizational skills from planning to execution of tasks and projects. - Attention to detail. - Excellent communication and client facing skills. - Excellent organizational skills. The salary range for this role is $60,000,00 to $65,000,00 in base pay and exclusive of any bonus or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location. Additional Information All your information will be kept confidential according to EEO guidelines. Technical Requirements (for remote workers only, not applicable for onsite/in office work): In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost. Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law. - Department: Revenue Cycle

Pharmacy Prior Authorization Specialist – Onco360 Pharmacy Buffalo, NY | Full-Time | Starting at $23.00/hr and up Join a mission-driven team making a difference in the lives of cancer patients. Onco360 Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our dedicated team in Buffalo, NY. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training. Company Benefits - Medical; Dental; Vision - 401k with a match - Paid Time Off and Paid Holidays - Tuition Reimbursement - Quarterly Incentive Bonus - Paid Volunteer Day - Referral Incentive Program - Company Paid Life Insurance; and Short/Long-Term Disability Why Join Us? - A career with purpose: Help patients access life-saving medications. - Supportive culture: We value teamwork, respect, integrity, and passion. - Growth opportunities: We invest in your professional and personal development. What You’ll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests. How You’ll Do This - Manage prior authorization requests and appeals with insurance carriers. - Collaborate with physicians, pharmacists, and other departments. - Ensure HIPAA compliance while handling sensitive patient information. - Maintain accurate documentation of authorization details. - Proactively monitor and renew expiring authorizations. What You Bring Required: - High School Diploma or GED - 1+ years of pharmacy or prior authorization experience - Registration with Board of Pharmacy (as required by state law) - Strong communication, organizational, and customer service skills - Self-motivated, organized, detail-oriented, and adaptable to changing priorities - Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds Preferred: - Associate degree or Certified Pharmacy Technician (PTCB) - 3+ years of experience in pharmacy or prior authorizations - Specialty pharmacy experience Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer. #Company Values: Teamwork, Respect, Integrity, Passion