Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Work Shift: Day (United States of America) Scheduled Weekly Hours: 40 Salary Range: $16.50 - $26.50 Union Position: No Department Details Opportunity to work remote Summary The Patient Access Specialist reviews and validates insurance eligibility, prior authorization and/or referral of medication, procedures, etc.; determines if insurance meets prior authorization criteria. Job Description Collects necessary documentation and communicates with third party payers, healthcare professionals and customers to prioritize requests. Verifies patient registration and confirms benefit coverage, including deductibles and out-of-pocket expenses; researches and verifies covered benefits for ordered tests, procedures, and other services. Responsible for assuring that prior authorization for medical services, including testing, procedures, surgery, Durable Medical Equipment (DME), and medications is completed and confirmed. Obtains diagnosis(es)/CPT code(s) from medical chart and/or provider office. Contacts third party payer to determine appropriate prior authorization process. Works closely with provider offices to obtain and clarify documentation to demonstrate medical necessity. If medical necessity criteria are not met, follows up with provider offices with guidance for Advanced Beneficiary Notices (ABN) or waivers that releases the financial burden of scheduled services from the facility to the patient. Reviews professional services denials; works with clinics and third party payers on appeal process. Assures all required referrals are in place; may work on outgoing referrals for care outside Sanford Health. May have minimal telephonic patient interaction concerning provider referrals. May notify appropriate insurance companies when patients have checked in for inpatient services and procedures requiring observation periods. Documents work in case management module; provides direction to utilization management, case management, and nursing regarding what action needs to be taken. Collaborates with case management, social work, utilization management, and other cross-functional teams across the enterprise. Assists with the design and management of data including the preparation of reports and presentations. Qualifications High school diploma or equivalent preferred; post-secondary education helpful. Minimum of two years of experience in a hospital or clinic setting required. Understanding of medical terminology, insurance background, office equipment and computers is required. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org.

At Palm Primary Care (PPC) our patients have the peace of mind knowing that their health and well-being are our primary concerns. We give our health plan clients the confidence that their members are well taken care of. With more than 24,000 at-risk members, we provide primary care and other services to seniors and families in our medical centers that are comfortable, convenient and staffed with caring professionals. Our activity and wellness facilities are filled with health plan members who know us for our distinct events and programs that cater to the communities we serve. Every day, we deliver on our promise to bring value based, quality healthcare to our patients. Overview PPC is looking for a CDI/Certified Professional Coder who will demonstrate deep knowledge in Medical Risk Adjustment, HEDIS, CNS Coding guidelines, billing standards and regulations. A teamwork person who will deliver a high standard of quality of work to drive improved business performance. Duties and Responsibilities - Conduct workflows in Coding and Quality processes, medical record completion and department projects for accuracy in medical record documentation as needed. - Ensures proper code selection for compliance with ICD-10-CM Official Guidelines for Coding and Reporting. - Educates physicians on proper documentation and compliance standards. - Reviews medical record to include consultations (inpatient and outpatient) and hospital discharge summaries to ensure continuity of care and continued coding for accurate risk adjustment. - Performs pre-post audits to ensure medical record completeness, consistency, and compliance. - Works collaboratively with medical and supporting staff to follow-up on documentation needs to support the diagnosis and quality measures based on patient age and chronic conditions. - Uses only pre-approved source documents as validation for recommendations on documentation that meets the technical specifications in support of a measure. - Develops and maintains professional skills and knowledge through training programs including education sessions for ICD-10-CM and CPT codes. - Demonstrates a thorough understanding of Coding Guidelines. - Demonstrates understanding of company policies which impact Coding functions and takes ownership for compliance for own area of responsibility. - Collaborates with Supervisor as necessary to clarify and verify information. Reports opportunities identified in concurrent and retrospective clinical documentation to support quality, regulatory compliance, and effective coding. - Participates in department meetings. Consistently demonstrates awareness and willingness to fulfill Service Excellence Commitments. - Works collaboratively with team members, other departments, and clinical staff consistent with the Mission and Vision of the company. - Willingly performs similar or related tasks as assigned. - Assists in teaching any office staff and/or providers in proper documentation and coding guidelines as necessary. - Reports any issues to Quality, Compliance and Operations as necessary. - Accurately enters all identified and validated procedures codes in claims into the practice’s EMR. - Assists in all RAPS submission projects as they occur if needed. - Performs all other coding and documentation reviews and/or projects as asked and assists/coordinates strategies as defined by the department head or assistant. Education and Experience: - Certified Professional Coder (CPC) through AAPC or AHIMA. - 2 years of experience as Certified Professional Coder at minimum. - Proficient in assigning ICD-10-CM codes according to provider documentation level to comply with federal regulations and insurance requirements. - Computer skills, Word, Excel, HER. - Ability to travel to medical centers if needed and/or work remotely. - Foreign graduate, nurse, or some Medical background is a plus. Required Skills/Abilities: - Excellent verbal and written communication skills. - Excellent customer service skills. - Excellent organizational skills and attention to detail. - Ability to effectively present information in one-on-one situations to providers, office staff, insurance companies, and other employees. - To perform this job successfully, an individual must have knowledge of Microsoft Word, Excel, Internet software, Email software, and insurance web sites. - Strong sense of business ethics. - Ability to follow company policies and procedures. Physical Requirements: - Prolonged periods of sitting at a desk and working on a computer. - While performing the duties of this job the employee is regularly required to sit, use hands and arms, talk and hear. - Must be able to lift up to 10 pounds at times. Benefits: - Health insurance - Dental Insurance - Vision insurance - Life insurance - 401(k) - Paid time off Schedule: - 8 hour shift - Day shift - Monday to Friday Job Type: Remote / Full-time Palm Primary Care is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Palm Primary Care makes hiring decisions based solely on qualifications, merit, and business needs at the time.

A Brief Overview Responsible for accurately and timely coding of moderately complex encounters following established coding, CMS regulations and hospital guidelines. Accurately codes diagnostic and procedural information following official coding guidelines, facility specific guidelines and federal regulations. What You Will Do - Reviews moderately complex medical records to identify sequence, code diagnoses and procedures according to established coding, CMS and hospital guidelines. - Responsible for accurately coding hospital same day surgery, observations, ancillary, ED encounters and/or professional services. - Ensures optimal CPT, ASC, APC, APG assignment as applicable. - Understanding and ability to resolve coding specific edits such as CCI, LCD, NCD, and MUE. - Supports OP Clinical Documentation Improvement program. - Maintains productivity and quality rate according to established standards. - Works within UH Billing time frames. - Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars. Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department. Maintains up to date credentials. - Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA). Additional Responsibilities - Participates in educational and informational activities as required. - Performs other duties as assigned. - Complies with all policies and standards. - For specific duties and responsibilities, refer to documentation provided by the department during orientation. - Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace. Education - High School Equivalent / GED (Required) - Associate's Degree preferably in HIM (Preferred) or Bachelor's Degree (Preferred) Work Experience - 2+ years ICD-10 CM, PCS and/or CPT coding experience (Required) Knowledge, Skills, & Abilities - Medical terminology, anatomy/physiology, pathophysiology and pharmacology knowledge (Required proficiency) - Detail-oriented and organized, with good analytic and problem solving ability. (Required proficiency) - Self-motivated with ability to function independently and as a team player in a fast-paced environment. (Required proficiency) - Strong written and verbal communication skills. (Required proficiency) - Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.). Must be able to proficiently work within with multiple systems. (Required proficiency) Licenses and Certifications - Certified Professional Coder (CPC) (Required Upon Hire) or - Certified Coding Specialist (CCS) (Required Upon Hire) or - Registered Health Information Technologist (RHIT) (Required Upon Hire) or - Registered Health Information Administration (RHIA) (Required Upon Hire) or - Certified Coding Associate (CCA) (Required Upon Hire) or - Radiology Coding Certification (RCC) (Required Upon Hire) or - Radiation Oncology Certified Coder (ROCC) (Required Upon Hire) or - Certified Hematology and Oncology Coder (CHONC) (Required Upon Hire) Physical Demands - Standing Occasionally - Walking Occasionally - Sitting Constantly - Lifting Rarely up to 20 lbs - Carrying Rarely up to 20 lbs - Pushing Rarely up to 20 lbs - Pulling Rarely up to 20 lbs - Climbing Rarely up to 20 lbs - Balancing Rarely - Stooping Rarely - Kneeling Rarely - Crouching Rarely - Crawling Rarely - Reaching Rarely - Handling Occasionally - Grasping Occasionally - Feeling Rarely - Talking Constantly - Hearing Constantly - Repetitive Motions Frequently - Eye/Hand/Foot Coordination Frequently Travel Requirements - 10%25

Role Description As a member of the Amazon One Medical Senior Health Revenue Cycle team, the Medical Coder I will be responsible for supporting Clinical and Revenue Cycle teams in reviewing the coding accuracy of claims. This role reports into the Manager I, Revenue Cycle. As part of Amazon Health Services, you will find yourself working with exceptionally talented and dedicated people committed to driving financial improvement, scalability, and process excellence. To support our growth, this candidate must possess a strong passion for accountability, setting high standards, raising the bar, and driving results through constant focus on improving existing and future state operations, systems, and processes in collaboration with management. - Managing multiple coding related projects and ensuring deliverables are up to One Medical standards while being turned around in an acceptable time frame - Remaining current on CPT, ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance - Assign appropriate ICD-10-CM, CPT, and other relevant codes to office visits, procedures, and diagnoses in a production environment - Responsible for the review and completion of email requests in a timely manner - Work collaboratively with the Medicare Risk Operations team to ensure positive program outcomes Qualifications - 1+ years of medical profee coding experience - CPC certification through AAPC or CCS certification through AHIMA - Experience in performing accurate and complete chart reviews for profee coding - Experience in profee auditing, coding, and documentation requirements Requirements - Demonstrates knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions - Demonstrates ability to perform accurate and complete chart reviews for Profee and HCC Risk Adjustment Benefits - Starting pay for this position is between 20.00 - 29.00 USD hourly - Starting Day 1 of employment, Amazon offers EAP, Mental Health Support, Medical Advice Line, 401(k) matching