• 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.

A brief summary of what's ahead Location: Hutchinson Regional Medical CenterFull Time Equivalent (FTE): 1Job position summary: Utilizes documentation from health care professionals to assign medical codes to patient records. The benefits have never been more rewarding. Here are a few things we offer: - Paid Parental Leave - Tuition reimbursement - Paid time off - Holiday premium pay - Shift and weekend differential pay - 401k with a 6% employer match - Medical, Dental, and Vision coverage - Employee assistance program Here is a look at the full job description: Medical Coder - Certified Outpatient - FT *Remote*Essential Responsibilities: Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position. - Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines. - Applies ICD-10-CM, CPT or modifier codes to accurately reflect patient visit documentation. - Utilizes coding software and any other coding resources to code inpatient or outpatient services, including diagnoses and procedures. - Abstracts required data elements i.e. discharge status, etc as defined by management. - Demonstrated ability to communicate coding issues to providers and submission of coding queries. - Promotes and maintains cooperation and communication with physicians and all staff and clientele to ensure satisfactory results in reimbursement. - Acts as a resource to providers, other coders and hospital billing office on coding questions, issues and resolution of billing edits. - Independently manages coding workload while applying complex coding principles in day-to-day job assignments. - Maintains a consistent coding quality accuracy rate that is equal to or greater than 95%. - Meets productivity expectations according to patient classifications established by management. - Act in accordance with the established mission, vision, and values. - Abide by the Health Insurance Portability and Accountability privacy and security regulations regarding all aspects of Protected Health Information (PHI). - Maintain effective communication and professional working relationships with patients/clients and their representatives, team members, contractors, physicians, peers, outside agencies, and the public. General Responsibilities: - Perform other duties as assigned. People Management Responsibilities: Does this position have people management responsibilities?: ☐ Yes 🗷 No “Yes” indicates that this position entails overseeing and guiding team members, encompassing employment decisions and/or suggestions, as well as conducting formal performance assessments. "No" indicates that this position does not involve managing team members. Minimum Qualifications: Required Education and Experience - Coding Credential Required License/Certifications/Registrations - CPC, COC, CCS, CCS-P, RHIT or RHIA Preferred Qualifications: Preferred Education and Experience - Experience in auditing and monitoring performance/accuracy of coding staff - Coding educator experience - Associate’s Degree - 2+ years coding experience in a similar healthcare facility and/or professional fee coding Preferred License/Certifications/Registrations - none Knowledge, Skills, and Abilities: - Knowledge of outpatient and professional ICD-10 CM and CPT coding standards. - Strong computer skills with comprehensive knowledge of medical records systems. - Goal-oriented with the ability to organize and prioritize work in an effective and efficient manner. - Demonstrate leadership, communication and interpersonal skills. - Knowledge and skills to provide support, advice and direction for management of medical record related applications as required. Physical Requirements: With or without accommodation. - Light Work: Occasionally exerting up to 25 lbs - frequently exerting up to 10 lbs. 11-25% of the day may be standing or walking. We provide equal employment opportunities Hutchinson Regional Healthcare System does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, marital status, veteran status, or any other status protected by applicable law. It is our policy to provide equal employment opportunities to all qualified individuals and to prohibit discrimination and harassment of any kind. We participate in E-Verify We will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the United States. If E-Verify cannot confirm that you are authorized to work, we are required to give you written instructions and an opportunity to contact the Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before we can take any action against you, including terminating your employment. We will only use E-Verify once you have accepted a job offer and completed form I-9.