Title: ASAM Licensing Specialist State Role Title: Prog Admin Specialist II Hiring Range: Up to $75,000 Pay Band: 5 Agency: Dept Behavioral Health/Develop Location: Central Office Agency Website: www.dbhds.virginia.gov Recruitment Type: General Public - G Job Duties The Virginia Department of Behavioral Health and Developmental Services (DBHDS) is seeking an experienced professional to serve as a Licensing Specialist in the Central Region. This position will provide regulatory technical assistance and conduct statute mandated inspections and investigations of licensed substance use providers to ensure individuals receiving care and treatment are receiving services consistent with the Rules and Regulations For Licensing Providers by the Department of Behavioral Health and Developmental Services [12 VAC 35 105]; the Amendments to align with enhanced behavioral health services [12 VAC 35-105] the Regulations for Children’s Residential Facilities 12VAC35-46; and the Amendments to align with the American Society of Addiction Medicine’s (ASAM) criteria 12VAC35-46. Regulations for Children’s Residential Facilities. The position will monitor provider compliance by reviewing complaints and reports of serious incidents and conducting inspections and investigations. Duties include issuing and modifying licenses and reviewing requests to modify services. Based on reviews, the Licensing Specialist will provide regulatory technical assistance to providers on how to comply with applicable regulations, as well as how to develop and implement systemic corrective actions for areas found not in compliance. Based on regulatory compliance, the LS will recommend licensing actions. This position is a field position requiring frequent daytime travel and infrequent overnight travel. It will be based in the Central Region and including localities such as Richmond, Henrico, Mechanicsville, Hanover, Charlottesville, Winchester, Fredericksburg, Culpepper, Warrenton and Front Royal and is approved for 100% telework. However, staff must be available for onsite office meetings/special projects, as requested by OL, at the DBHDS Central Office located in Richmond, Virginia. It’s strongly suggested that applicants live within a 30-40 mile radius of the region, in order to meet the duties and demands of the position. A valid, unrestricted driver’s license and an acceptable driving record in accordance with the Commonwealth’s Driver Safety Program are required. Minimum Qualifications Understanding of clinical assessments and how they tie to service plan development and implementation. Experience working with individuals with substance use disorders, mental health diagnoses and/or developmental disabilities. Administrative, management and/or quality assurance experience with public and private service delivery systems. Experience in interpreting regulations and policies. Ability to develop professional relationships as a foundation for providing guidance and discussing potential concerns with providers, along with the ability to communicate verbally and in writing with internal and external stakeholders. Additional Considerations Certified Substance Use Counselor. Knowledge of and experience using the ASAM levels of care for treatment or to monitor service compliance. Regulatory experience. Special Instructions You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position. For consideration, interested applicants must apply by completing the online application and/or submit a resume. However, emailed, faxed, and hand-delivered applications and/or resumes will not be accepted. Applications must be submitted by 11:55 p.m., on the listed closing date. Reasonable accommodations are available to persons with disabilities during application and/or interview processes per the Americans with Disabilities Act. DBHDS welcomes all applicants authorized to work in the U.S. For more information on how to seek this authorization, please refer to Working in the United States or contact the U.S. Citizenship and Immigration Services office directly. For any technical assistance with the jobs.virginia.gov website, please contact applicantinquiry@dhrm.virginia.gov. Contact Information Name: ShaKiera Miles Phone: N/A Email: shakiera.miles@dbhds.virginia.gov - Inquiries Only/No Submissions, to include resumes. In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019. Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.

Welcome to Ovation Healthcare! At Ovation Healthcare (formerly QHR Health), we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions. The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare’s vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior. We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare, you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork. Ovation Healthcare’s corporate headquarters is located in Brentwood, TN. For more information, visit www.ovationhc.com. Summary: The Billing Specialist is responsible for managing the daily billing and ensuring timely accurate clean claims, claim reviews and resolves billing daily claim edits and ensuring compliance with Insurance billing policies and regulations. Duties and Responsibilities: - Extensive understanding of billing guidelines for UB/1500 claims and a deep understanding of each claim field requirement. - Maintain a list of split billing requirements by payer and add to the team crosswalk and keep abreast of any payer changes. The billing specialist should be well versed in Payer portal appeal uploads and assist with providing the internal team feedback when necessary. - Import claims from host system into claims processing system when required. Review claims that are pended for edits and resolve. - Prepare and submit accurate claims for patient services, ensuring compliance with third party payer guidelines and regulations. - Review patient accounts and reconcile payments with secondary payers and review remittance advice, ensuring all payments are posted correctly and outstanding balances are addressed before filing the secondary payer. - Ensure all billing and collection practices are compliant with CMS regulations, HIPAA, and company policies. Maintain accurate records of all claims and ensure proper documentation in the patient account system. - Meet daily productivity and quality standards as assigned. - Work with internal departments, such as patient financial services, finance, and billing, to address any issues or disputes affecting patient accounts. - Assist management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows. Knowledge, Skills, and Abilities: - Proven experience in third party insurance billing, collections, or patient accounts, preferably in a healthcare setting. - In-depth knowledge of billing codes, guidelines, and regulations. Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing. Strong communication skills, with the ability to explain Medicare billing details and resolve patient concerns effectively. - Ability to handle sensitive information and maintain confidentiality in accordance with HIPAA regulations. - Detail-oriented with strong organizational skills and the ability to manage multiple accounts simultaneously. - Problem-solving abilities, particularly regarding billing discrepancies and denied claims. Work Experience, Education, and Certifications: - Experience utilizing Payer portals, client systems and clearing house requirements - 3-5 years of experience as a primary biller in hospital Business Office. Medical Terminology, ICD-10, CPT and DRG knowledge a preferred, knowledge of third-party Insurance payer guidelines - High school diploma or equivalent; additional training in medical billing is a plus. Working Conditions: Work from home and remote location with a stable internet connection, a quiet and dedicated workspace free of distractions, and access to necessary office equipment. The ability to have daily communication with team members, management, and clients through email, phone calls, video meetings and other collaborative tools. Primarily requires sitting at a desk for extended period. Proper lighting and ergonomics shole be maintained to reduce eye strain. 100% Remote

Job Description: The RCO Appeals Specialist is responsible for researching and appealing denied medical claims. Responsible to proactively identify insurance denial trends and to then work with Payer Contracting on these issues.We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Pennsylvania, Rhode Island, Vermont, and Washington. Colorado for remote caregivers’ whose assigned Intermountain facility or service area is not based in Colorado. Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings Essential Functions - Understands and uses various contracts and laws (i.e., ERISA, self-funded, State and Federal insurance) to appropriately appeal medical claims that have been denied. - Conducts and refers patient accounts when requested by payers, audit firms, patient and RCO departments to determine the appropriateness of billed charges, chargemaster data, revenue cycle data and UB/HCFA1500 information that is on the claim. - Interpret and accurately identify the true reason of the denial and review payer contracts, clinical data and other data to be able to appeal in a correct and concise way. - Assesses the appropriateness of clinical appeal requests by working with and using evidence- based utilization review criteria, payer policies and Federal and State regulations. - Refers appeal cases to the designated Physician Advisor and works with them to obtain support for appeals. - Collaborates with Care Management, Physician Advisors, Revenue Integrity, Compliance, legal counsel, and RSC teams to prepare appeals. - Identifies trends and opportunities for denial prevention and collaborates with the appropriate multidisciplinary teams to improve denial management, documentation, and appeals process. - Supports legal counsel to prepare for Administrative Law Judge hearings as part of the appeal process. - Serves as a subject matter expert, resource and mentor to others within the RCO, clinical departments, Appeal RN’s, legal, IPAS and Payor Contracting on the art of appealing. Skills - Medical billing - Interpersonal skills - Communication - Healthcare Regulations - Insurance regulations - Medical terminology - Critical thinking - Problem solving - Patient advocate - Collaboration Qualifications Required - Demonstrated experience in a healthcare revenue cycle role - Demonstrated proficiency in computer skills including Microsoft Office, internet and email - Demonstrated experience in a role utilizing exceptional written communication skills - Demonstrates knowledge of State/Federal/ERISA and self-funded insurance laws Preferred - Demonstrated experience in healthcare insurance billing, follow-up, denials and appeals or audit role. - Bachelor’s degree preferred. - Experience with Epic preferred. Physical Requirements - Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs. - Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately. - Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc. - May have the same physical requirements as those of clinical or patient care jobs, when the leader takes clinical shifts. - For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles. Location: Lake Park Building Work City: West Valley City Work State: Utah Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $21.84 - $33.23 We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package here. Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process. All positions subject to close without notice.

SUMMARY: The Authorization Specialist is responsible for securing timely and accurate insurance authorizations for both inpatient admissions (elective, urgent/emergent) and outpatient surgical day care procedures. This role ensures compliance with payer requirements, supports revenue cycle integrity, and plays a critical part in optimizing financial outcomes by combining healthcare finance knowledge with strong analytical and communication skills. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Authorization & VerificationFinancial Analytics & Revenue OptimizationPatient Interaction & CollectionsDenial Prevention & Bad Debt ReductionDocumentation & Complianceh3/h3 - Obtain and document prior authorizations for inpatient admissions and outpatient surgical procedures from commercial and government payers. - Verify patient insurance coverage and eligibility prior to scheduled procedures and admissions. - Ensure all authorizations are in place to avoid delays or cancellations. - Complete notification of admission for inpatient admissions. h3/h3 - Conduct financial analytics to determine a patient’s estimated financial responsibility across the healthcare system. - Interpret payer contracts and state/federal regulatory guidelines to ensure accurate reimbursement and maximize revenue realization. - Collaborate with revenue cycle and clinical teams to identify and resolve authorization-related issues that may impact reimbursement. h3/h3 - Communicate with patients regarding their financial obligations, including co-pays, deductibles, and out-of-pocket costs. - Secure upfront payments or establish payment arrangements prior to the date of service. - Provide clear and empathetic financial counseling to patients, ensuring understanding and satisfaction. h3/h3 - Minimize claim denials by ensuring all authorization and documentation requirements are met. - Work proactively to reduce bad debt through timely patient collections and accurate financial clearance. - Monitor and report trends in denials and collaborate with internal teams to implement corrective actions. h3/h3 - Maintain accurate and up-to-date records of all authorization activities in the electronic health record (Epic) and patient accounting systems. - Ensure compliance with HIPAA, payer guidelines, and internal policies. - Participate in audits and quality improvement initiatives as needed. MINIMUM QUALIFICATIONS: Education & ExperienceSkills & Competenciesh3/h3 - High school diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare administration, finance, or related field preferred. - Minimum 2 years of experience in medical authorization, patient access, or revenue cycle operations, preferably in a surgical or ambulatory care setting. h3/h3 - Strong understanding of healthcare finance, insurance verification, and payer authorization processes. - Proficiency in interpreting payer contracts and regulatory guidelines. - Excellent analytical, problem-solving, and communication skills. - Ability to work independently and collaboratively in a fast-paced environment. - Experience with EHR systems (e.g., Epic, Cerner) and Microsoft Office Suite. Pay Range: $22.04-$36.37 EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location: Remote-Massachusetts - N/A Boston, Massachusetts 02108Work Type: M-F 8:00am-4:30pmWork Shift: DayDaily Hours: 8 hoursDriving Required: Yes