• This is an Advanced Level III position in which the employee has demonstrated an advanced knowledge of ICD-10 CM-PCS and CPT coding guidelines and is fully competent to independently code the most complex inpatient and or outpatient service types and resolve any associated edits. • Responsible for responding to coding related questions from other departments and for assisting in reviewing and responding to denials. • May be called upon to represent coding in meetings. • Reviews work queue assignments and prioritizes work by date, charges and payors to meet revenue cycle goals. • Assigns and sequences diagnosis and procedure codes using appropriate classification systems and official coding guidelines to insure that DRG (Diagnosis-related group) or APC (Ambulatory Payment Classification) assignment is correct. • Codes inpatient (IP), same day surgery (SDC), observation (OBS), emergency department (ED), recurring (RCR), and clinical (CLI) records, including the assignment of ICD-10-CM, Procedure Categories, modifiers (when applicable) and HCPCS/CPT codes across multiple facilities and possible E/M levels. • Reviews documentation and possibly charges to correctly assign outpatient procedure codes (ED Only). • Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current. • Initiates physician query in compliance with Company policy when appropriate. • Reassign accounts with missing or incomplete documentation/charges to appropriate work queues. • Correctly abstracts discharge disposition, performing physician, and procedure dates. • Corrects discharge disposition based on payer requirements. • In- depth knowledge of coding and charging requirements necessary to resolve billing edits at time of coding. • Works with revenue cycle to resolve issues related to billing. • Ability to audit coding quality and provide feedback on an as needed basis. • As a remote employee must be able to organize work to ensure goals are met. • Identifies and escalates any obstacles to fulfilling job responsibilities. • Must maintain coding certification, continue to work towards knowledge base growth by cross-training to learn other patient types and attend in-service training as required. • Attends and actively participates in huddles/meetings/committees as required and appropriate.

Job Summary Our organization is continuing to grow, and we are currently seeking a Certified Surgical Coder to join our team. The ideal candidate will have demonstrated experience in General Surgery, Interventional Radiology, and Trauma coding, and will play a key role in ensuring accurate, compliant, and efficient coding practices. We are looking for a detail-oriented professional who is committed to maintaining high standards of quality while supporting the overall efficiency of our coding operations. Identifies and applies appropriate ICD-10 diagnostic and CPT procedural codes to individual patient health information for claims processing, data retrieval and analysis. Responsible for patient financial related activities, which includes accurate entry of insurance benefits, authorizations and other activities which ensures complete and accurate claims. Required Qualifications - Require a minimum of two (2) years of experience in a physician office.- Require a minimum of one (1) year of CPT and ICD physician coding experience.- Require Certified Professional Coder (CPC) or Certified Coding Specialist - Physician-based (CCS-P), or Certified General Surgery Coder (CGSC), or become certified within one (1) year of employment. Preferred Qualifications - Prefer a college degree.- Prefer demonstrated initiative and the ability to work in a self-directed environment.- Prefer Multi-Specialty coding experience.- Prefer basic knowledge of third party payers.- Prefer demonstrated ability to establish and maintain working relationships.- Prefer previous experience with medical terminology.- Prefer demonstrated basic accounting and math skills.- Prefer demonstrated computer, keyboard, and data input skills.- Prefer demonstrated ability to manage multiple tasks and priorities in a high volume setting.- Prefer knowledge of electronic health records software and skill in all Microsoft office software programs (Word, Excel, Outlook, Power Point, Access).- Prefer demonstrated effective verbal and written communication skills. Mandatory Education HS EQ: High School Diploma, GED or Certificate *Please note that a copy or photo of your High School Diploma or GED is required prior to start - or transcripts showing date of completion/graduation (this is collected during our onboarding process). Preferred Education AD: Associate's Degree Work Days/Shift/Start Time This position will be remote following the completion of the training period. Training on-site will vary based on training time needed (those needing more training will be required to be on-site for longer timeframe). Must be FL resident. Will be required to complete pre-employment onboarding appointment and new employee orientation in Sarasota, FL. Training will be at SMH Support Service buliding which is located downtown Sarasota, FL on Main Street. Employment Screening Requirements As part of Sarasota Memorial Health Care System’s commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse. https://info.flclearinghouse.com/

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. Luminis Health is not responsible for any charges incurred by the recipient. Candidates are encouraged to review their mobile carrier's plan for applicable text messaging rates and usage charges.

Role Description The Medical Records Technician (Clinical Documentation Improvement Specialist - Inpatient) classifies medical data from patient health records in the hospital and/or physician based settings. The coding practitioner analyzes and abstracts patients' health records and assigns alpha-numeric codes for each diagnosis and procedure. Responsibilities - Reviews overall quality and completeness of clinical documentation. - Applies comprehensive knowledge of medical terminology, anatomy, and physiology, disease processes, treatment modalities, diagnostic tests, medications, and procedures. - Prepares and conducts provider education on documentation processes in the health record. - Adheres to accepted coding practices, guidelines, and conventions. - Monitors changing regulatory and policy requirements affecting coded information. - Expertly searches the patient health record to find documentation justifying code assignment. - Develops and conducts seminars, workshops, short courses, informational briefings, and conferences. Work Schedule - Full-Time, 0800-1630 (subject to change) Pay - Competitive salary and regular salary increases. - A higher step rate of the appropriate grade may be determined after consideration of higher or unique qualifications or special needs of the VA. Paid Time Off - 37-50 days of annual paid time off per year (13-26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year). - Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. Parental Leave - After 12 months of employment, up to 12 weeks of paid parental leave in connection with the birth, adoption, or foster care placement of a child. Child Care Subsidy - After 60 days of employment, full-time employees with a total family income below $144,000 may be eligible for a childcare subsidy up to 25% of total eligible childcare costs for eligible children up to the monthly maximum of $416.66. Retirement - Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA. Insurance - Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement). Remote - This position is remote work eligible and is currently exempted from return to office requirements. Qualifications - Knowledge of coding and documentation concepts, guidelines, and clinical terminology. - Knowledge of anatomy and physiology, pathophysiology, and pharmacology. - Ability to collect and analyze data and present results in various formats. - Ability to establish and maintain strong verbal and written communication with providers. - Knowledge of regulations that define healthcare documentation requirements. - Extensive knowledge of coding rules and regulations, including current clinical classification systems. - Knowledge of severity of illness, risk of mortality, and complexity of care. - Knowledge of training methods and teaching skills sufficient to conduct continuing education for staff development. Preferred Experience - 3+ years coding experience. Basic Requirements - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - Experience: One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - Education: An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management. - Certification: Persons hired or reassigned to MRT (Coder) positions must have either Apprentice/Associate Level Certification, Mastery Level Certification, or Clinical Documentation Improvement Certification. Grade Determination - Experience: One year of creditable experience equivalent to the journey grade level of a MRT (Coder-inpatient). - Certification: Employees at this level must have either a mastery level certification or a clinical documentation improvement certification.