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.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description MU Health Care is looking for a detail-oriented Medical Coding Specialist to join our team. As a crucial member of our healthcare family, the ideal candidate will possess a passion for precision and a commitment to maintaining the highest standards in medical coding. We value individuals who demonstrate a deep understanding of technical coding principles, coupled with a strong knowledge of ICD-10-CM, ICD-10-PCS, and CPT codes. Our ideal candidate advances their coding expertise through continuous education, ensuring accurate and compliant coding practices. We seek someone who thrives in a fast-paced environment, excels in problem-solving, and actively contributes to audits, troubleshooting, and training initiatives. If you're ready to make a meaningful impact on healthcare billing, reporting, and regulatory compliance, join MU Health Care and be a vital part of our commitment to excellence in patient care. Qualifications - One of the following certifications: - Certified Coding Associate (CCA) by the American Health Information Management Association (AHIMA) - Certified Coding Specialist (CCS) by AHIMA - Registered Health Information Technician (RHIT) by AHIMA - Registered Health Information Administrator (RHIA) by AHIMA - Certified Professional Coder (CPC/CPC-A) by the American Academy of Professional Coders (AAPC) - Certified Outpatient Coder (COC/COC-A) by AAPC - Certified Inpatient Coder (CIC/CIC-A) by AAPC - Specialty certification per the department needs such as: Radiation Oncology Certified Coder (ROCC) by the American Medical Accounting and Consulting Inc (AMAC) Requirements - Review appropriate provider documentation to determine: - Principal diagnosis - Co-morbidities and complications - Secondary conditions - Surgical procedures - Utilize technical coding principles and MS-DRG or APC reimbursement expertise to assign appropriate ICD-10 codes and/or CPT-4 codes. - Review and correct patient admission source, status, and disposition upon discharge. - Abide by the Standards of Ethical Coding as set forth by AHIMA and adhere to Official Coding Guidelines. - Advance coding knowledge and practice through continuing education. - Extract required information from clinical documentation and enter into the encoder and abstracting system, in accordance with prescribed coding productivity standards. - Perform additional coding support activities including: - Audits for correct coding and billing - Testing and troubleshooting problems when implementing new applications or updates - Assisting with training for new software applications - Inpatient Coding Staff: - Assign Present on Admission (POA) value for all inpatient diagnoses. - Consult with the Clinical Documentation Specialist to resolve unspecified or questionable diagnoses. - Outpatient Coding Staff: - Identify chargeable items for visits and enter corresponding charges into the billing system. - Hold Bill & Denials Staff: - Work inpatient and/or outpatient coding related bill alerts/edits/denials. - Enter detailed notes to update the financial system if the alert/edit cannot be resolved. - Escalate alert/edit resolution issues as appropriate. - May complete unit/department specific duties and expectations as outlined in department documents. Benefits - Health, vision and dental insurance coverage starting day one - Generous paid leave and paid time off, including nine holidays - Multiple retirement options, including 100% matching up to 8% and full vesting in three years - Tuition assistance for employees (75%) and immediate family members (50%) - Discounts on cell phone plans, rental cars, gyms, hotels and more Physical Demands The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required to ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs. Equal Employment Opportunity The University of Missouri is an Equal Opportunity Employer.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Processes referral requests for patients to achieve timely and accurate determinations. Works within scope of practice to complete or forward requests as appropriate to Managed Care physicians and/or nurses as per the Utilization Management (UM) protocols. Maintains required turnaround times for referral completion. Assists providers and patients with referral status questions. Participates in development and implementation of improvements to the referral process and workflows. This role has the opportunity to work at home. The person selected will be required to report to the affiliate, hub location or other Sutter Health facility as requested to meet operational needs. Qualifications - HS Diploma or GED Requirements - Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge. - Competency in using MS Office Excel and Word, other Managed Care programs. - Ability to identify, understand and solve problems related to claims and referrals. - Communication skills, including understanding of medical concepts, ability to organize thoughts, and communicate issues concisely and effectively. - Proven ability to quickly adjust to changing projects and priorities and to multi-task. - Organizational skills. Benefits - Comprehensive benefits package. Company Description Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $30.12 to $37.64 / hour. San Francisco Bay Area Pay Range is $30.12 to $37.64 / hour. Sacramento Valley Area Pay Range is $26.19 to $32.73 / hour. The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program.