Role Description The Associate, Authorization is a position responsible for ensuring that patient care services are ready to bill accurately and in a timely manner. The primary responsibility of the role is to obtain authorization for care from insurance carriers and provide denial support. This position will serve as a liaison between the service office providers, insurance carriers, and revenue cycle management functions. A high level of customer service and support is required to obtain insurance authorization and effectively communicate clients’ coverage. Qualifications - Exemplifies characteristics of The BAYADA Way: compassion, excellence, and reliability. - Four (4) year college degree. - Prior healthcare and/or home care experience preferred. - One (1) year of relevant work experience obtaining authorizations and verifying eligibility is preferred. - Demonstrated record of strong interpersonal skills and building relationships. - Self-motivated, flexible, and versatile. - Strong customer service skills. - Demonstrated record of goal achievement. - Basic PC skills required to perform job functions. - Proven ability to multitask and manage competing priorities. - Ability to sort and arrange information and files in an appropriate manner. Requirements - Demonstrate and communicate the core values of BAYADA and The BAYADA Way. - Develop working knowledge of BAYADA’s mission, services, people, organization, policies, and procedures. - Provide backup support for routine support questions. - Meet metrics that support BAYADA’s goals and objectives and measure effectiveness. - Prepare reports and presentations using Microsoft Office (Word, Excel, PowerPoint, etc.). - Support annual audits and compliance reviews, as needed. - Learn various aspects of the organization through technology training, hands-on learning, cross-training, and site visits. - Support authorization and eligibility workflow within appropriate system/s. - Communicate effectively and maintain positive working relationships with insurance companies, referral sources, service offices, etc. - Perform related duties, or as required or requested by supervisor. Other Responsibilities - Manage a caseload and provide customer support for dedicated service offices. - Perform utilization management (review plan of care and utilization requests) to ensure proper number of days are requested. - Respond timely to requests and/or escalate review of denied requests. - Communicate with insurance companies via portals, phone, or other third-party systems to request authorization. - Support supplies and referral management. - Provide any support to revenue cycle teams regarding authorization discrepancies or payor requirement changes. - Submit appeals to insurance companies. - Obtain denial letters from primary insurance companies when a secondary carrier is being billed yearly or as needed. - Review and interpret authorization for services rendered to mitigate claim/EDI errors and denials. Benefits - Base Pay: $21.64/hour - BAYADA offers a comprehensive benefits plan that includes: - Paid holidays, vacation, and sick leave - Vision, dental, and medical health plans - Employer paid life insurance - 401k with company match - Direct deposit - Employee assistance program Company Description BAYADA believes that our employees are our greatest asset. As an accredited, regulated, certified, and licensed home health care provider, BAYADA complies with all state/local mandates. BAYADA is celebrating 50 years of compassion, excellence, and reliability.

• Ensure data readiness for important milestones including, but not limited to, interim analysis, final analysis, snapshots to support submissions, Data Monitoring Committee reviews and publications • Review participant level data across a study in adherence with CRF Completion guidelines (CCGs) and the Data Review Plan (DRP) • Conduct point-to-point data checks (e.g. verifying the presence of a lab test that satisfies study inclusion criteria) and interpretive analysis (e.g. reviewing to identify inconsistencies in the participant’s data). • Generate queries on discrepant data and follow to resolution including escalation of issues that cannot be resolved through the query process • Create and use data review best practices and associated data review tools to identify trends and any safety signals • May identify protocol deviations during routine clinical review and escalation as appropriate • Follow relevant SOPs and regulations, have an excellent understanding of and comply with applicable training requirements, constantly seeking further improvements in quality and efficiency of clinical procedures • May liaise with data management, clinical and site management along with other members of the study team Attend Clinical Meetings and Study Meetings, as necessary

• Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff. • Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. • Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria. • Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. • Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. • Documents all communication with medical office staff and/or treating provider. • Practices and maintains the principles of utilization management by adhering to policies and procedures. • Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations, as well as, being audited to ensure guidelines are applied appropriately.

Title: Clinical Reviewer - PASRR (2026-49948) Location: United States Job Description: Job Number: 2026-49948 Category: Healthcare Shift: Day Exempt/Non-Exempt: Exempt Business Unit: ForHealth Consulting Department: ForHealth Consulting - Community Service - W401950 Job Type: Full-Time Num. Openings: 2 Work Location: 100% Remote Salary Minimum: USD $60,000.00/Yr. Salary Maximum: USD $78,000.00/Yr. Job Summary Under the general supervision of the Associate Director, or designee, the Clinical Reviewer - PASRR is responsible for reviewing submitted referrals and any accompanying clinical documentation to the Pre-Admission Screening and Resident Review (PASRR) unit for completeness. The Clinical Reviewer- PASRR may also complete Abbreviated Level II evaluations in accordance with relevant guidelines and regulations. This position facilitates individuals with suspected serious mental illness (SMI), seeking admission to or currently residing in a nursing facility, receive an in person or abbreviated evaluation and nursing facility placement determination. Major Responsibilities - Participate as an active member of a multi/inter-disciplinary team to evaluate and determine the appropriateness of nursing facility placement for individuals with suspected SMI. - Complete thorough review of all referrals and accompanying clinical documentation for completeness and determines if the referral can be moved to an abbreviated or full PASRR Level II evaluation. - Demonstrate an ability to use critical thinking skills to identify when to conduct additional outreach or review on assigned cases and when to escalate to assigned supervisor. - Complete Abbreviated Level II evaluations on an individualized basis, but in accordance with the most current federal rules, regulations, and evaluative criteria and required timeframes. - Review and document all relevant information into data system applications in accordance with program guidelines and regulations. - May participate in the preparation of appeals for determinations made through the PASRR process. - Prepare and respond to requests for statistics and resource/service data. - Foster and promote continuity of care and cooperative partnerships by liaising with health care providers, acute care hospitals and other programs/organizations involved in the provision of services. - Maintain positive working relationships with individuals served, and relevant informal supports, provider organizations, and state agencies. - Maintain the confidentiality of all business documents and correspondence per UMass Chan Medical School/ForHealth Consulting procedures and HIPAA regulations. - Participate in performance improvement initiatives and demonstrates the use of quality improvement in daily operations. - Participate in training and mentoring of new clinical reviewer staff. - Comply with established departmental policies, procedures and objectives. - Comply with all health, safety and program regulations and requirements. - May participate in public relations efforts, attending conferences and meetings as needed. - Perform other similar and related duties as required or as directed. Required Qualifications - RN, LPN or social worker licensed to practice in Massachusetts with an appropriate degree - 3-5 years work experience with at least 3 recent years providing direct service or case management - Expertise in working with individuals with mental health behavioral health issues. - Ability to understand and utilize resources for problem solving, in order to deal with problems involving multiple variables, effectively prioritizing and executing tasks in a high pressure, fast paced environment. - Ability to work weekends Preferred Qualifications - Extensive experience with program related services/populations preferred Supervision Supervision Received Will be supervised by clinical coordinator. Supervision Exercised This position does not include supervisory responsibilities. Environmental Working Conditions Remote position which requires working at computer for all tasks. Posting Disclaimer: This job posting outlines the primary responsibilities and qualifications for the role but is not intended to be an exhaustive list. Duties and expectations may evolve in response to the needs of the department and the broader institution. In alignment with our commitment to pay transparency, the base salary range for this position is listed above (exclusive of benefits and retirement). At UMass Chan Medical School, final base salary offers are determined based on a combination of factors, including your skills, education, and relevant experience. We also consider internal equity to ensure fair and consistent compensation across our teams. Please note that the range provided reflects the full base salary range for this position. Offers are typically made within the midrange to allow for future growth and development within the role. In addition to base pay, UMass Chan offers a comprehensive Total Rewards package, which includes paid time off, medical, dental, and vision coverage, and participation in a 401(a)-retirement plan, with the option to contribute to a voluntary 403(b) plan.