Role Description This position is located in the Health Information Management (HIM) section at the Phoenix VA Medical Center. MRTs (Coder) are skilled in classifying medical data from patient health records in the hospital setting and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. - Selects and assigns codes from the current version of several coding systems to include ICD, CPT, and/or HCPCS. - Assigns codes to documented patient care encounters (outpatient and/or inpatient professional services) covering the full range of health care services provided by the VAMC. - Patient encounters are often complicated and complex requiring extensive coding expertise. - Applies advanced knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection. - Adheres to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or evaluation and management (E/M) code to ensure ethical, accurate, and complete coding. - Applies codes based on guidelines specific to certain diagnoses, procedures, and other criteria used to classify patients under the Veterans Equitable Resource Allocation (VERA) program that categorizes all VA patients into specific classes representing their clinical conditions and resource needs. - Performs a comprehensive review of the electronic health record to abstract medical, surgical, ancillary, demographic, social, and administrative data to ensure complete data capture. Qualifications - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - English Language Proficiency: MRTs (Coder) must be proficient in spoken and written English. - Certifications: MRT (Coder) GS-0675 must have either (1), (2), or (3) below: - (1) Apprentice/Associate Level Certification through AHIMA or AAPC: - Certified Coding Associate (CCA) - Certified Professional Coder-Apprentice (CPC-A) - Certified Outpatient Coding-Apprentice (COC-A) - (2) Mastery Level Certification through AHIMA or AAPC: - Certified Coding Specialist - Physician-based (CCS-P) - Registered Health Information Technician (RHIT) - Registered Health Information Administrator (RHIA) - Certified Professional Coder (CPC) - Certified Outpatient Coder (COC) - Certified Inpatient Coder (CIC) - Certified Coding Specialist (CCS) - (3) Clinical Documentation Improvement Certification through AHIMA or ACDIS: - Clinical Documentation Improvement Practitioner (CDIP) - Certified Clinical Documentation Specialist - Preferred Experience: 1 year as a Certified MRT (Coder-Inpatient) Requirements - Experience: One year of creditable experience equivalent to the next lower grade level. - Demonstrated Knowledge, Skills, and Abilities (KSAs): - Ability to analyze the health record to identify all pertinent diagnoses and procedures for inpatient coding and to evaluate the adequacy of the documentation. - Ability to accurately perform the full scope of inpatient coding, including inpatient discharges, surgical cases, diagnostic studies and procedures, and inpatient professional services. - Skill in interpreting and adapting health information guidelines that are not completely applicable to the work or have gaps in specificity, and the ability to use judgment in completing assignments using incomplete or inadequate guidelines. Benefits - Full-Time, Monday - Friday, 7am - 3:30pm - This is a virtual position. - Relocation/Recruitment Incentives: Not Authorized

Title: Pharmacy Medical Billing Revenue Cycle Representative Location: Iowa City, Iowa, United States (Hybrid) Offsite 26003916 Job Description: Come Join Our Team! The Revenue Cycle Representative is a financial position in the healthcare industry necessary for hospital and pharmacy billing practices. This position requires strong computer skills, a high level of attention to detail, strong organizational skills, a general knowledge of hospital and medication billing practices, and excellent customer services skills. The Revenue Cycle Representative will work closely with both pharmacy and clinical staff within the hospital to support clinic administered and outpatient medically billed medications including infusions. Support includes, but is not limited to, benefits investigation, prior authorization completion, copay assistance support, and assistance with patient access. This position is eligible for a combination of remote work and in-person (hybrid) work within Iowa. To be eligible for the hybrid remote work option, staff must be working in the position for a minimum of 6 months, must have successfully completed all training requirements, and must be meeting or exceeding expectations as assessed in a formal performance review or by leadership. A work arrangement form will be required to be completed prior to the start of remote work. Per policy, work arrangements will be reviewed annually, and must comply with the remote work program and related policies and employee travel policy when working at a remote location. POSITION RESPONSIBILITES: - Medication Access Support: - Assist patients and staff with benefits investigation and prior authorization completion for medication therapies billed to the medical benefit. - Communicate with patients, pharmacists and/ or providers to gather required information. - Verify patient insurance eligibility, benefits, coverage limitations, and authorization requirements. - Initiate and follow through for required prior authorizations, which may include pharmacy or medical authorizations. - Track authorization requests and follow up with payors to ensure timely determination. - Assist clinical pharmacy specialists or other providers with initiation of appeals when applicable. - Assist with copay/coinsurance assistance when applicable. - Monitor authorization expiration dates and obtain renewals for ongoing therapies. - Maintain accurate documentation of all authorizations within the electronic health record. - Communicate with patients, insurance companies, prior authorization and to assist with resolution of patient account inquiries. - Appeal/troubleshoot claim payments and/or denials using available resources. - Participate in process improvement and workflow optimization initiatives aimed at reducing authorization delays and improving patient access to care. - Assist the pharmacy coding and billing team with the resolution of claims issues. - Provide accurate documentation of all activities as required by accrediting agencies, payers and/or administration. - Monitor reimbursement activity for medications to ensure UI Health Care receives full and accurate reimbursement for services in compliance with payor rules and regulations. - Adhere to compliance standards and policies to ensure UI Health Care receives full and accurate reimbursement for services in compliance with payor rules and regulations. - Provide the highest customer service experience for patients and providers. - Operations and Performance Standards: - Utilize tools and processes to maximize the efficiency of the revenue cycle. - Resolve pharmacy billing discrepancies and identify possible trends. - Identify areas to improve the billing process. - Identify areas to improve the benefits investigation and prior authorization process. - Comply with established cash handling policies and procedures of the institution and department. - Assist with the evaluation and implementation of new products/technology. - Assist with the evaluation and implementation of new policies and procedures. - Participate in standard pharmacy operations as the need arises. - Reporting: - Analyze, identify, and report trends found during workflow or as assigned. - Compile information for audits as they arise from compliance and insurance/third party payors in a reportable manner. - Report discrepancies found during analysis. - Document activities required by accrediting agencies, payors and/or administration (i.e. workload statistics, phone statistics, etc.). - Communication/Training: - Communicate with providers, payors, patients, co-workers, supervisors and departments to resolve revenue cycle issues. - Understand the importance of effective business communication and maintaining professionalism in difficult situations. - Participate in orientation of pharmacy technicians, pharmacists, pharmacy residents and others within the department on medical billing practices for medications. - Complete and maintain compliance with all competencies and educational requirements. - Other duties as assigned Education Requirements: - Completion of a Bachelor's degree or equivalent combination of education and experience. - Successful completion of the pharmacy technician certification exam within twelve months of the start of employment. Experience Requirements: - Previous experience in customer service - Experience and proficiency with computer software applications (i.e. Microsoft Office Suite - Word, Excel, Outlook, PowerPoint) or comparable programs. - Strong attention to detail and proven ability to gather and analyze data and keep accurate records. - Self-motivated with initiative to seek out additional responsibilities and tasks along with generating suggestions for improving workflow. - Effective verbal and written communication skills, active listening skills and the ability to maintain professionalism while handling difficult situations. - Demonstrate effective problem solving abilities and meets challenges with resourcefulness. - Familiarity with medical terminology. Desired Qualifications: - Experience working in a complex hospital system is highly desirable. - Medical medication management experience is highly desirable. - Medical billing experience is highly desirable. - Experience working in a collaborative team environment is desirable. - Pharmacy experience is desirable. - Knowledge of healthcare billing and prior authorization process, experience working with insurance and/or federal and state assistance programs is desirable. - Experience working with multiple technology platforms (i.e. Epic, GE) is desirable. - Knowledge and understanding of the Health Insurance Portability and Accountability Act (HIPAA) is desirable. This position is eligible for a combination of remote work and in-person (hybrid) work within Iowa. To be eligible for the hybrid remote work option, staff must be working in the position for a minimum of 6 months, must have successfully completed all training requirements, and must be meeting or exceeding expectations as assessed in a formal performance review or by leadership. A work arrangement form will be required to be completed prior to the start of remote work. Per policy, work arrangements will be reviewed annually, and must comply with the remote work program and related policies and employee travel policy when working at a remote location. Additional Information - Classification Title: Revenue Cycle Representative - Appointment Type: Professional and Scientific - Schedule: Full-time - Work Modality Options: Hybrid within Iowa Compensation - Pay Level: 2B

Role Description The Certified Coder I performs functions of coding diagnosis and procedures from outpatient center/clinic records utilizing International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. (Potential Remote) Typical Duties: - Assigns codes to diagnosis and procedures of outpatient records, including clinics, Urgent Care, and Emergency room, utilizing ICD and CPT codes in accordance with ICD Coding Guidelines, CPT Coding Guidelines, American Hospital Association (AHA) Coding Clinics, and the JPS Outpatient Coding Policy and Procedures. - Ensures codes are assigned accurately and sequenced correctly ensuring reimbursement is appropriate in accordance with government, insurance, and/or other payer regulations. - Identifies, researches, and corrects or routes accounts on the coding and billing edit work queues to meet coding guidelines and facilitate accurate billing. - Queries the provider when documentation is determined to be insufficient, conflicting, or ambiguous to elicit documentation reflecting the most accurate and specific conditions or procedures. - Maintains productivity and quality standards set forth in the District’s outpatient coding standards. - Utilizes online and hard copy coding reference materials. - Works closely with Outpatient Coding Supervisor and the health center/clinic medical and nursing staff regarding documentation and notification of charging issues. - Demonstrates evidence of professional growth by attending coding workshops, conferences, and/or seminars, maintaining required C.E. requirements (departmental and professional), and individual study and education regarding coding, reimbursement, and HIM competencies. - Performs other job-related duties as assigned. Qualifications - Required Education and Experience: High School Diploma, GED, or equivalent. - Preferred Education and Experience: 1 year outpatient coding experience. - Required Licensure/Certification/Specialized Training: At least one of the following registrations or certifications: - American Health Information Management Association (AHIMA): Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT), Certified Coding Specialist (CCS), or Certified Coding Administrator (CCA). - American Academy of Professional Coders (AAPC): Certified Professional Coder (CPC) or Certified Professional Coder-Hospital Outpatient (CPC-H). Company Description JPS Health Network is a $950 million, tax-supported healthcare system in North Texas. Licensed for 582 beds, the network features over 25 locations across Tarrant County, with John Peter Smith Hospital a Level I Trauma Center, Tarrant County's only psychiatric emergency center, and the largest hospital-based family medical residency program in the nation. The health network employs more than 7,200 people. Acclaim Multispecialty Group is the medical practice group featuring over 300 providers serving JPS Health Network. Specialties range from primary care to general surgery and trauma. The Acclaim Multispecialty Group formed around a common set of incentives and expectations supporting the operational, financial, and clinical performance outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time. When working here, you're surrounded by passion, diversity, and dedication. We look forward to meeting you!

Role Description The Virtual Benefits Coordinator is responsible for obtaining and documenting insurance eligibility and benefits for patients receiving infusion therapy. This position plays a critical role in ensuring accurate insurance verification, identifying coverage requirements, and supporting timely patient care by maintaining complete and up-to-date benefit information within the practice's systems. The Virtual Benefits Coordinator works primarily within the WeInfuse platform, prioritizing the verification queue, and collaborates closely with the infusion, billing, and clinical teams to ensure seamless communication regarding patient insurance coverage and authorization requirements. This position is co-managed by the Billing Manager and the Infusion Manager. Essential Duties and Responsibilities - Insurance Verification - Verify patient insurance eligibility and benefits for infusion services. - Contact commercial insurance companies, Medicare, Medicaid, and other payers to obtain accurate benefit information. - Utilize insurance carrier portals and payer websites to verify eligibility and benefits whenever available. - Determine coverage for both: - Infusion drug (J-code or applicable HCPCS code) - Drug administration (CPT administration code) - Identify and document payer requirements including: - Prior Authorization - Medical Necessity requirements - Pre-determination - Referral requirements - Coverage limitations - Deductibles, coinsurance, copays, and out-of-pocket responsibilities - Documentation - Maintain accurate and detailed documentation within the WeInfuse platform. - Complete all required verification fields manually and update each patient's verification status. - Prioritize and manage the WeInfuse Verification Queue to ensure timely completion of insurance verifications. - Document detailed notes regarding insurance conversations, reference numbers, representative names, and benefit information. - Enter and maintain insurance information within eClinicalWorks (eCW). - Update patient insurance information in eCW when new or changed coverage is identified. - Patient Communication - Contact patients when clarification regarding insurance coverage is needed. - Obtain updated insurance information from patients as necessary. - Communicate patient financial responsibility when directed by practice policies. - Maintain professional and courteous communication with patients at all times. - Team Collaboration - Communicate benefit verification findings promptly with: - Infusion Nurses - Billing Department - Billing Manager - Infusion Manager - Other Benefits Coordinators - Additional infusion staff as needed - Escalate insurance concerns or coverage issues to appropriate leadership. - Collaborate with the billing and infusion teams to resolve insurance-related issues that may impact scheduling or treatment. - System Management - Maintain proficiency in: - WeInfuse - eClinicalWorks (eCW) - Insurance carrier portals - Medicare and commercial payer websites - Ensure all documentation is accurate, complete, and entered in a timely manner. - Follow HIPAA guidelines and maintain patient confidentiality at all times. Qualifications - High school diploma or equivalent. - Minimum of one year of medical insurance verification, benefits coordination, or medical billing experience. - Experience verifying medical insurance benefits. - Strong understanding of medical terminology. - Experience working with electronic medical records (EMR). - Excellent written and verbal communication skills. - Strong organizational and time management skills. - Ability to prioritize multiple tasks in a fast-paced environment. - Attention to detail and high level of accuracy. Preferred Qualifications - Experience with infusion therapy benefit verification. - Experience using WeInfuse. - Experience using eClinicalWorks (eCW). - Knowledge of HCPCS (J-codes) and CPT administration codes. - Experience with prior authorizations and payer medical policies. Core Competencies - Insurance verification expertise - Critical thinking and problem-solving - Excellent documentation skills - Effective communication - Team collaboration - Time management - Attention to detail - Customer service - Confidentiality and professionalism Reporting Structure - Co-Managed By: - Billing Manager - Infusion Manager Work Environment - Remote/Virtual position. - Extensive computer and telephone use throughout the workday. - Regular interaction with insurance companies, patients, providers, and internal staff. - Must maintain a secure and HIPAA-compliant remote work environment. Performance Expectations - Timely completion of insurance verifications. - Accuracy of benefit documentation. - Effective prioritization of the WeInfuse verification queue. - Accurate maintenance of insurance information within eCW. - Clear and timely communication with infusion and billing teams. - Reduction in treatment delays related to insurance verification. - Compliance with practice policies, payer requirements, and HIPAA regulations.