• support the overall business strategy by performing analysis to provide data informed decisions. • formulate solutions and recommendations to complex business problems or processes. • utilize your insurance knowledge, analytic methods and technical skills to extract actionable insights to inform business strategy and provide valuable risk management recommendations. • play a crucial role in shaping the data foundation and fostering a robust data focused culture. • participate in and may lead large cross-functional projects. • provide guidance, mentorship and training to develop lower-level associates, with accountability for team success. • performs complex data analysis for commercial insurance related to overall business objectives. • research includes enlisting the collaboration of different departments and gaining their support on findings and action plan. • types of analyses may range from, but not limited to, root cause, cost benefit, performance tracking, forecasting, and exploration, with a strong focus on generating actionable insights. • consult with client group to identify and scope business needs and issues. • determine course of action, timeline and necessary participants. • prepare findings and recommendations for clients and present to senior leaders. • partner closely with IT partners to provide business definitions and data architectural inputs, perform User Acceptance Testing on digital and data assets. • create and maintain key business intelligence artifacts, will be the owner and SME on the accuracy and logic.

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: - We serve faithfully by doing what's right with a joyful heart. - We never settle by constantly striving for better. - We are in it together by supporting one another and those we serve. - We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level. Job Summary The Insurance Verification Specialist 1, under general supervision, provides insurance benefit information to patients, physicians, and hospital staff. This position ensures timely insurance verification and financial clearance. This directly impacts the organization's reimbursement from payers for both scheduled and unscheduled patient accounts. Essential Functions of the Role - Perform financial clearance of patient accounts by verifying insurance eligibility and benefits. Ensure all notifications and authorizations are completed on time. - Completes appropriate payor forms related to notification and authorization. - Coordinates the submission of clinical documentation from physicians to payers for authorization needs. - Calculates accurate patient financial responsibility. - Communicates promptly with Utilization Review. Collaborates effectively with the physician and facility staff. Ensures financial clearance of the patient's account before any service during the hospital stay. - Interprets complex payer coverage information, including network participation status, limited plan coverage, and inactive benefits. - Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement. Key Success Factors - 1 year of healthcare or customer service experience preferred. - Must have the ability to consistently meet performance standards of production, accuracy, completeness and quality. - Ability to understand and adhere to payer guidelines by plan and service type. - Requires good listening, interpersonal and communication skills, and professional, pleasant and respectful telephone etiquette. - Maintain a professional demeanor in stressful and emotional environments. Handle behavioral health and suffering patients, including life or death situations. - Must exhibit high empathy and communicate well with patients and families during traumatic events. Demonstrate exceptional customer service skills. - Demonstrates ability to manage multiple, changing priorities in an effective and organized manner. - Excellent data entry, numeric, typing and computer navigational skills. Basic computer skills and Microsoft Office. Belonging Statement We believe that all people should feel welcomed, valued and supported. QUALIFICATIONS - EDUCATION - H.S. Diploma/GED Equivalent - EXPERIENCE - 3 years of Authorization Processing Experience

This is a 100% remote opportunity; however, please only apply if you have 3 to 5 years of medical insurance collection experience. AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD) and Infusion Care. With our diverse culture, and our values around Innovation, Stewardship, and Unity, we are committed to Advancing Quality and Improving Lives. We are dedicated to doing more for our patients by providing quality products and services that enhance the entire care experience. AIS Healthcare is looking for experienced and motivated Accounts Receivable Collection experts to join our dynamic team! The AR Collection role is a full-time position responsible for collection processes for TDD services that includes contract analysis, reimbursement, denial management, appeals and resolving billing-related issues with insurance companies or other responsible party for services rendered. The perfect candidate should have an in-depth knowledge of collection practices related to billing and collection activities. AIS Healthcare offers great benefits, including health, vision and dental insurance, long term disability insurance, life insurance, a vacation package, and a 401K plan with a generous employer match. Additionally, we offer a 100% work from home model. EDUCATION AND EXPERIENCE: - A high school diploma or general education degree (GED) equivalent is required. - 3-5 years of healthcare industry experience required. - 3-5 years of medical billing and collections experience required. - Home Infusion, Intrathecal Pain Management experience preferred. ESSENTIAL DUTIES AND RESPONSIBILITIES: - Recognizes patients’ rights and responsibilities and supports them in the performance of job duties, respects patient’s rights to privacy and confidentiality. - Follows up on invoices submitted to ensure prompt and timely payment and escalates issues, as necessary. - Evaluates payments/denials received for correctness and ensures they are applied accordingly. - Identifies bad debt write-offs and A/R adjustments. Initiates write-offs and adjustments in accordance with policies and procedures. - Identifies any overpayments and/or duplicate payments and investigates and resolves accordingly. - Processes refund requests, in accordance with policies and procedures. - Maintains contact with other departments to obtain patient or insurance information needed for claim payment. - Responsible for understanding all procedures within regulatory mandates. - Ensures that the activities of the collection operations are conducted in a manner that is consistent with overall department protocol, and are following Federal, State, and payer regulation, guidelines, and requirements. - Makes calls to troubleshoot payment discrepancies and establish resolution. - Documents, in detail, phone calls, phone number, person spoken to, and call details on a consistent basis. - Consistently looks for areas to maximize claim reimbursement. - Resolves issues that created a denial within 5 days of receipt of denial. - Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations. - Maintains understanding of NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies. - Maintains a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes. - Shares knowledge gained with other staff members and works as a team member. - Interacts with others in a positive, respectful, and considerate manner. - Performs other job-related duties as assigned. QUALIFICATION REQUIREMENTS: - Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations. - Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders. - Strong work ethic with personal qualities of integrity and credibility. - Self-directed, detail oriented, conscientious, organized, and able to follow through. - Ability to deal in an organized manner with problems involving multiple variables within the scope of the position. - Tolerant of frequent interruptions and distractions from staff and other internal support teams. - Proficient in Microsoft Office, including Outlook, Word, and Excel. Steps to Apply: To apply for this role, you must complete a Culture Index Assessment to be considered.Please note that your application will not be considered if the Assessment is not completed. Copy and paste the following link into your browser and press enter. Then, select the corresponding position for which you are applying. (Only one assessment per candidate is required.) The assessment is brief, taking less than ten minutes to complete. portal.cultureindex.com/public/survey/general/0BFB8F0000 AIS HealthCare™is the leading provider of advanced sterile, patient-specific intrathecal pump medications and in-home intravenous infusion, including immune globulin therapies. These services, combines with your advanced nursing and care coordination solutions, assist physicians and hospitals in delivering a superior level of care for optimal therapeutic outcomes. We offer a wonderful work culture, looking for an impact player who is positive, earnest, and hardworking.

This position is Remote in the states of Washington OR Oregon. You will have the flexibility to work remotely* as you take on some tough challenges. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Pre-authorization Specialist implements, maintains and executes procedures and processes by which Optum performs its referral and authorization process. This position responds to inquiries from patients, staff and physicians pertaining to referral authorization questions. The position also researches medical history and diagnostic tests when requested, to assist in review, processing, and coordination of prospective, concurrent and retrospective referrals. This position is full-time, Monday - Friday. Employees are required to work during our normal business hours of 7:00am - 4:30pm Monday - Thursday and 8:00am - 12:00pm Friday PST. It may be necessary, given the business need, to work occasional overtime. We offer on-the-job training. The hours of the training will be aligned with your schedule Primary Responsibilities: Initiate Referral Authorizations: - Acquires and maintains a working knowledge of Optum contracted health plans agreements and related insurance products - Provides administrative and enrollment support for team to meet Company goals - Gathers information from relevant sources for processing referrals and authorization requests - Submits authorization & referral requests to health plan via avenue of insurance requirement. Including but not limited to website, phone, & fax - Track authorization status inquires for timely response - Maintains strong understanding of and educate our physicians, clinical teammates, patients and families regarding contracted health plans requirements related to Referrals/Pre-authorization Management - Acts as a liaison between providers, teammates, outside vendors, health plans, community services and patients to support Referrals/Pre-authorization management process and requirements - Reviews benefit language and medical records to assist in completion of requested services, to meet health plan requirements - Documents patient information in the electronic health record following standard work guidelines - Coordinates with Clinical teammates and health plans to identify patients with Referrals/Pre-authorization Management needs - Provides member services to all patient group - Answers referral and authorization inquiries from health plans, our clinical areas, patients and outside Optum Physician office/facilities - Assists in the development and implementation of job specific policy and procedures - Assists in the collection of information for member and/or provider appeals of denied requests - Identifies areas for potential improvement of patient satisfaction Review Denied Claims (No Authorization/No Referral): - Researches root causes of missing authorization/referral - Processes no authorization, no referral denied claims based on Insurance plans billing guidelines - Obtains retro authorizations, appeals denied claims, or writes off charges based on Optum charge write-off guidelines - Provides feedback and follow up to clinical areas and appropriate parties - Assists in the development and implementation of job specific policies and procedures to reduce no authorization no referral denied claims to increase revenue - Initiates improvement in authorization timeliness, accuracy and reimbursement Utilization Management Medical Review: - Processes Insurance plan referrals in EPIC - Utilizes Prior Authorization list, MCG, NCCN, and individual insurance plan medical guidelines/policies to determine administrative review, what is needed for clinical review, and manages the work flows accurately - Reviews clinical records to match insurance medical guidelines/policies, acquires additional records if necessary - Discuss medical guidelines with insurance plan to reduce referral/prior authorization denial rate, expedite referral authorization process, and to keep peer to peer opportunities to minimal - Document accurately and timely in medical record - Processes referrals in timely manner to improve patient’s satisfaction - Other duties as assigned You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: - High School Diploma / GED OR equivalent years of work experience - Must be 18 years of age OR older - 1+ years of experience in healthcare, including understanding of health plan related operations - Experience in Referrals/Pre-authorization Management/Claims billing - Experience with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications - Experience with Microsoft Outlook, Microsoft Word & Microsoft Teams - Experience with EHR/EMR systems (i.e.Epic) - Willingness and ability to travel annually for an on-site meeting at the Everett, WA office. - Ability to work full time. Employees are required to work during our normal business hours of 7:00am - 4:30pm Monday - Thursday and 8:00am - 12:00pm Friday PST. It may be necessary, given the business need, to work occasional overtime Preferred Qualifications: - 1+ years of experience in Referrals/Pre-authorization Management - 1+ years in appeal writing and processing - 1+ years working knowledge of EOB, COB, Remits, and CMS 1500 - Knowledge of organizational policies, procedures, & systems - Working knowledge of CPT & Diagnosis Coding, Medical Terminology, and basic Anatomy Telecommuting Requirements: - Reside within the states of Washington OR Oregon - Ability to keep all company sensitive documents secure (if applicable) - Required to have a dedicated work area established that is separated from other living areas and provides information privacy - Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.98 - $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.