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

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Required to pay meticulous attention to detail and have proficient knowledge of the electronic health record (Epic) in order to review and validate completeness and accuracy of medical record documentation for inpatients, ambulatory surgery, emergency department, and various outpatient encounters as indicated. Incumbent must demonstrate expert level knowledge of HIM pertinent Rules and Regulations for each delivery network and have the ability to validate automated deficiencies and/or manually assign deficiencies as appropriate. Identifies discrepancies and makes any necessary corrections to dates of service, missing core elements, and/or assignments. Participates in weekly alert and notification process to support routine suspension protocols. Assist medical staff members with Epic training and questions regarding record completion work flow. EEO/AA/Disability/Veteran Responsibilities 1. From the Epic Analysis Needed work queue, analyzes the on line medical record for inpatient, ambulatory surgery, and/or emergency department patients as well as various outpatient encounters. Determines completeness and accuracy of information as prescribed by hospital regulations, the Joint commission on Accreditation of Health Care Organizations and appropriateness state/federal regulations initiating appropriate action to correct any deficiencies noted. 1.1. Highlight the assigned discharge in the Analysis needed work queue and open the Episode to review the Deficiency Completion activity for the discharge. Review the Summary tab and the Deficiency tab to view a summary of the episode and details regarding each deficiency. 1.2. Click the Def Detective to review the summary of the patient's hospital stay and add or modify deficiencies to note any further work needed in the chart. 1.3. For any deficiency which has been amended or needs to be edited by the attending for missing information, attach a message using one of the departments Smart Text/Phrases. 1.4. When assigning deficiencies refer to hospital and department procedures and policies, and clinical department guidelines to accurately assign deficiencies to physician(s) responsible for completion of deficiencies. 2. Monitors and maintains the Epic Analysis work queue as assigned by the Senior Analysts to ensure, timely and accurate statistical reporting notification to physicians on status of incomplete medical records assigned to them for record completion. 2.1. Reviews deficiencies in the Declined work queue which the physician has declined and the reason. Based on the documentation in Epic make the decision to complete, reassigns to another physician or sends back the deficiency to the physician. 2.2. Before re-assigning a declined deficiency to another physician, reviews the audit trail of the edits that have occurred to a deficiency validating any other physicians who might have already declined. Reviews any messages from physicians that appeared in its earlier states. 2.3. Reviews deficiencies in the Done work queue which have been marked by physicians as completed. Verifies the documentation is complete and attach to the patient's chart. If the document is 'not' complete, send it back to the provider. 2.4. Reviews deficiencies in the Final Analysis work queue to make sure that all documentation is complete and all required information is present. Marks the chart episode as final or closed to remove it from the Incomplete Chart report. 2.5. Performs other related duties and special assignments as requested and directed by the supervisor or manager. Assists supervisor with training of staff in changes and new procedures. 3. Ensures adherence to hospital procedure regarding timely completion of delinquent medical records as outlined in the Hospital By Laws. Follows the department guidelines for notification and suspension of physicians who fail to complete their records within the required timeline. 3.1. Reviews each deficiency on the physician's Alert Letter of Delinquent Medical records assigned to them for monitoring. Reviews the Epic documentation to ensure that each deficiency is assigned to the correct physician(s), the deficiency status is accurate and that it is under the correct visit. 3.2. Follows up daily with physician's compliance with completion of delinquent deficiencies appearing on the Alert Letter sent to them for completion. Sends certified letters based on Alert Letters that have generated for records >14 days. Performs physician follow-up on prescribed schedule. 3.3. Upon approval, generates from Epic a Suspension of Admitting Privileges and Temporary Withdrawal of Clinical Privileges to the attending. Sends a copy of the letter to other designated individuals/departments as outlined in the HIM department policy and procedure. All suspension documentation, which includes fax confirmation is to be filed in the suspension book following the HIM department procedure and updates the attending?s status in the Provider Report. 3.4. Checks daily to determine if physicians have completed their records. Once all records (delinquent and non-delinquent) assigned to the physician are completed, a Restoration Letter from Epic letter to attending and a copy of the letter faxed to other designated individuals/departments as outlined in the HIM department policy and procedure. Updates the attending?s status in the Provider Report. 3.5. Assists in any/all necessary deficiency report cleanup and analysis for all delivery networks. 3.6. Verifies and updates appropriate spreadsheets with new information as indicated. 3.7. Performs according to departmental productivity guidelines 4. Provides assistance to physicians and secretaries responding to telephone and walk-in request/inquires in a timely manner. Assists patients/customers in providing good customer service. Demonstrates acknowledgement of responsibility to practice and promote good customer relations and mutual respect 100 % of the time. 4.1. Assists physicians with Epic training and issues with regarding record completion work flow. Supplies Epic Tip Sheets when needed and serves as the physician liaison. Answers policy and procedure questions regarding record assignment/completion trying to resolve the issue or return the call by the end of the day supplying or updating the physician or the office with the appropriate information. 4.2. Works with physicians to ensure that all of the deficiencies in an episode are complete and properly documented according to quality standards. 4.3. Exercises good judgment when required to make a decision regarding the appropriate action to be taken, working independently to resolve issues before referring problems to the Senior Analyst/Supervisor. 5. From time to time will complete special projects as assigned by the supervisor or manager. Qualifications EDUCATION Associates degree in healthcare related field or equivalent experience as a Documentation Integrity Technician; RHIA or RHIT preferred. EXPERIENCE Two (2) to three (3) years of health information management experience required; formalized training in medical record documentation requirements to ensure regulatory compliance. LICENSURE RHIA or RHIT preferred. SPECIAL SKILLS Requires knowledge of medical terminology and a thorough knowledge of a variety of regulations concerning the content of Medical Records. Thorough understanding of Documentation Integrity and MR Completion Policy. Working knowledge of computers for data entry and search and retrieval. Accurate keyboard skills ( 30-35 wpm). Ability to use peripheral equipment such as bar code scanners, printers, fax machine, photocopier. Ability to effectively communicate verbally and to deal professionally with co-workers, other departments, and medical personnel. Knowledge of various software packages. YNHHS Requisition ID 172437

Overview What We Do We calm the confusion of IT by guiding the connection between people and technology. If a customer is looking for a better way to manage their warehouse inventory, equip their workforce, or secure their data, we make it happen. All it takes is finding the right combination of tech hardware, software, cloud solutions, and support services. That’s what we do. We’re the IT Department’s IT Department. Who We Are Our team is made stronger by a multitude of backgrounds, experiences, and perspectives. It’s what makes Connection unique—what drives us to innovate and create technology solutions that stand apart from the crowd. We’d love for you to be a part of that fabric, to share your ideas and experiences with a team that thrives on fresh thinking, creativity, and helping others. Why You Should Join Us You’ll find supportive teammates and a rewarding career at Connection—plus great benefits. We take pride in supporting employees with a total rewards package that provides financial, emotional, and physical resources for you and your family. Our compensation, 401k plans, medical insurance, and other benefits are progressive and competitive. We value the importance of our employees’ emotional wellbeing. To support employees, we provide free therapy visits, mental health coaching and tools, and meditation resources. You’ll also enjoy a generous paid time off package that includes not only vacation and sick time, but also Wellness and Volunteer Time Off days. Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time. Responsibilities Works with many suppliers, both EDI and non-EDI, processes a large number of orders each day; reviews data entry and responds to large volumes of email and phone calls with follow-up.Checks for order accuracy, processes electronic orders and modifies / changes orders placed by our sales team and customers.Executes daily exception reports and filling back orders.• Ensures accuracy of order processing and reviews reports for any exceptions or issues.Executes daily exception reports for EDI ordersEmails follow-ups with the Sales team and/or vendors regarding orders• Conducts strategic purchasing and planning for product availability and shipping on orders received, as needed.Compiles information on sources cost and manufacturer discounts.Analyzes vendor and manufacturer data on factors that affect prices.Reviews contract costs and RMA policy for long term agreements.Reviews proposals, selects suppliers, verifies delivery and approves payment.• Performs all other duties or special projects as assigned. Min USD $19.65/Hr. Max USD $24.57/Hr. Qualifications Basic computer knowledge with ability to operate keyboard for data entry.• Working knowledge of Microsoft Office Suite with ability to create a document or simple spreadsheet.• Experience working in the computer reseller industry is required. (i.e. manufacturer, distributor, reseller, etc.).• Strong negotiation skills with ability to be firm.• Experience working with and understanding of computer products and part numbers.• Attention to detail in composing, keying, and proofing professional business materials• Working knowledge with problem resolution, customer service, and working with vendors, suppliers, and sales.• Moderate experience inputting large volumes of data in a timely manner• Adaptable with ability to complete tasks while working under pressure and deadlines.• Excellent verbal communication skills with ability to present professional demonstrations• Excellent written communication skills with ability to compose professional business communications via email, letter, and proposals.• Interpersonal skills with ability to work well with all levels of the organization and maintain good working relationships with customers• Organized state of mind with ability to document activities, anticipate problems, plan schedules and monitor performance according to priorities and deadlinesBecause of the possibility for fraudulent job postings on many popular job boards, please be advised that Connection will never offer a position of employment without a complete interview process and communication with a “live person".