Employment Type: Full timeShift: Day Shift Description: Job Title: Credentialing Specialist Employment Type: Full-time Shift: Day Location: Remote, seeking a candidate local to PA or DE Position Purpose - The Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has strong ties and a close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. As a “Credentialing Specialist” you will: - Responsible for the management of the physician and mid-level providers credentialing process. - Timely completion and submission of all applications for credentialing. - Ensures all providers (physician and mid-level) are enrolled in each insurance plan to secure reimbursement for services rendered. - Integral part of the onboarding process of new providers as it relates to individual payer credentialing and new practice set up with payers. - Process NPI application/changes. - Completes all paperwork for electronic funds transfers (EFT), claims submission and remit (EDI) processes. - Maintain provider credentialing and insurance carrier files, including all certifications, licenses, CVs and malpractice information on past claims. Minimum Qualifications: - Hight School graduate or Equivalent (required) - Associate degree (preferred) - 2+ years of relevant experience (required) - CPCS (preferred) [FT/PT Benefit eligible Roles]: **0.5 FTE (20 hours weekly) up to 1.0 FTE (40 hours weekly) Position Highlights and Benefits: - Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.  - Work/Life balance with flexible schedules.  - Free onsite parking.  - Our mission and core values are what drive each member of Trinity Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all.   - Referral Rewards Program Position Highlights: - Work/Life balance with flexible schedules.  - Free onsite parking.  - Our mission and core values are what drive each member of Trinity Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all.   - Referral Rewards Program St. Mary Medical Center is a beautiful 53-acre state-of-the-art facility comprised of more than 700 physicians, nearly 3,000 colleagues, and 1,100 volunteers committed to providing quality care delivered with compassion and respect. St. Mary attracts top doctors, introduces cutting-edge technologies and implements advanced procedures to meet the healthcare needs of the people it serves, including the nearly 630,000 residents of Bucks County. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Great people. Great careers. Join the team at Great Plains Health, where you can be a part of something, well, great. Job Title: HIM Coding Specialist Cost Center: Health Information Management Job Description: The HIM Coding Specialist is responsible for coding accurately, diagnoses and procedures utilizing the International Classification of Diseases, Clinical Modification (ICD-9/10-CM) and/or the Current Procedural Terminology (CPT) coding systems. Assigns ICD-9/10-CM codes in the proper sequence to reach the appropriate DRG. Minimum Qualifications o Education o Completion of required course work and/or degree for accreditation or registration with the American Health Information Management Association (AHIMA). o Credentials o State Required: None o GPRMC Required/Preferred: Required are accreditation as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Certified Coding Associate (CCA) with the American Health Information Management Association (AHIMA). Also, a recent Health Information Management (HIM) or Health Information Technology (HIT) graduate is preferred if accreditation is successfully completed within 6 months of employment. Membership in Clinical Coding Society (a division of AHIMA) is preferred. Physical Demands 1. Stand and/or walk frequently. 2. Sit frequently. 3. No lift and/or carry. 4. No push and/or pull. 5. Visual acuity and manual dexterity within normal limits. 6. Bend, stoop, and crouch occasionally. 7. Reach floor to overhead occasionally. 8. Computer use frequently. Essential Functions 1. Demonstrates competency in Medical Record Abstract, Medical Record Control, Medical Record Index, and DRG/Case Mix applications in Affinity system. Demonstrates competency in using 3M Encoder. Demonstrates competency using ChartMaxx imaging system. 2. Abstracts and verifies information such as service codes, time of discharge, surgical data, transferring status, observation times, and physician relationship (admitting, attending, primary care, consulting, surgeon, assistant surgeon, etc.) from the medical record. Codes on records of patients under Series Outpatient Service Codes, Parent Accounts prior to the end of the month in which the Parent Account was created, if possible. Checks for uncoded Child accounts on said records on a routine basis. 3. Demonstrates competencies established by Department Director/Coding DRG Coordinator. Demonstrates competency in ICD-9/10-CM and CPT coding by coding pursuant to coding rules of said coding systems. 4. Assigns diagnostic and operative/procedure codes for inpatient and outpatient records, utilizing ICD-9/10-CM. Assigns CPT codes and Revenue Codes on Emergency Department (EDA/EDS service codes), Same Day Services (SDS), and other patients who have undergone outpatient procedures. 5. Reviews each medical record to be coded, ensuring that there is sufficient documentation to support the ICD-9/10-CM or CPT-4 codes assigned. Checks deficiencies and inconsistencies in the medical record. Obtains, either personally or in cooperation with other HIM staff, GPRMC staff, or physicians, any missing medical necessity documentation. 6. Demonstrates ability to reorganize work in order to satisfy fluctuations in volume and staffing adjustments. Codes records as assigned and prioritized by the Coding/DRG Coordinator. 7. Reviews APC edits on outpatient accounts and add modifiers when necessary to produce clean billing claim, 8. Provides coding assistance to Home Health in the absence or direction of the Coding/DRG Coordinator. 9. Participates in audits of medical records for coding accuracy. Actively participates in education opportunities for continuing education and professional growth. 10. Performs other duties as assigned by Coding/DRG Coordinator or HIM Director. Join us. Join great. Join the dynamic team at Great Plains Health and be a part of something truly exceptional. At Great Plains Health, we embody a culture defined by authenticity, integrity, and a genuine commitment to listening to both our patients and each other. As a member of our team, you'll experience a supportive environment where collaboration is key, and every voice is valued. We work together seamlessly, leveraging our collective strengths to provide the highest quality care to our community. Passion drives us forward, propelling us to constantly strive for excellence in everything we do. If you're seeking a rewarding career in healthcare surrounded by like-minded individuals who share your dedication and enthusiasm, Great Plains Health is the place for you. Come join us and be part of a team that's making a real difference every day.

Work From Home Work From Home Work From Home, Indiana 46544 Some people love getting to the bottom of things -- chasing down denied claims, resolving accounts, digging through the details to identify discrepancies and needs. Yes, we’re talking about people who love collections. And it takes a love of getting into the details to do this job well. 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 - Conduct inquiries via phone, mail, fax, or electronically to conduct follow-up on the accounts that have been denied and resubmitted for payment. - Conduct follow-up with insurance carriers, physicians, and other stakeholders that can validate and assist with actions and information needed to properly review, dispute or appeal denial until a determination is made to conclude the appeal. - Ensure information sent to insurance carriers has all release of information necessary and is HIPPA compliant. - Analyze reports and use software to track, trend and identify root causes of denials; offer suggestions for process improvement to resolve denial issues, supported by documentation and data. - Review denials and payment discrepancies identified through the denial system, which are directly related to the verification, authorization and registration process. - Prepare and submit patient record requests from care delivery sites and provide correspondence to patient on requested information. QUALIFICATIONS - Preferred Associate's Degree - Required High School Diploma/GED - 2 years Revenue Cycle with strong AR account follow-up, appeals, billing and/or coding knowledge OR Insurance Verification/Patient Accounting Required TRAVEL IS REQUIRED: Never or Rarely JOB RANGE: Denial Reimburse Specialist $23.43 - $30.46 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.

Work From Home Work From Home Work From Home, Indiana 46544 The Referral Management Coordinator is responsible for processing internal, incoming, and external referrals for all ambulatory services. This position will obtain prior authorizations, schedule patients, work inbound and outbound phone calls. PEAC Referral Management Specialists are responsible to engage in conversations with patients on their responsibilities for copayment, prepayment, and outstanding balance and engage in the POS collection process. WHO WE ARE Franciscan Health is a leading healthcare organization dedicated to providing exceptional patient care and promoting health and wellness in our community. Our mission is to ensure that every patient receives the highest quality of care through innovation, compassion, and excellence. 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 who provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT - Ensure current and standardized referral policies and workflows are followed and utilized on a regular basis. - Prioritize referrals by their urgency and address them in a timely manner. - Ensure complete demographic, insurance information, and appropriate/pertaining clinical information is sent to referred specialists. - Contact insurance companies to ensure prior approval requirements are met. - Present necessary medical information such as history, diagnosis, and prognosis to insurance companies if deemed necessary to prove the medical necessity of services. - Review details and expectations about the referral with ordering providers and patients. QUALIFICATIONS - Required High School Diploma/GED - 2 years Medical referrals, healthcare, and or prior authorization Required TRAVEL IS REQUIRED: Never or Rarely JOB RANGE: Referral Management Coordinator $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.