Specialist jobs at St. Luke's Health System

This position is a full time temporary position. The position is to end 04/04/2026 Why MediGold? MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We're dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. About the job: Provider Service Specialist responds in a timely and accurate manner to provider inquiries made by phone, in person and in writing regarding Plan benefits, services and payment determinations. What you'll do: * Receive, interpret and accurately respond to provider inquiries, both verbally and in writing in accordance with department standards, policies and procedures. * Consistently document and accurately code all inquiries within designated software applications, within required Plan timeframes and according to Plan documentation policies * Review, investigate and advise providers regarding claims status and payment determinations * Maintain a comprehensive knowledge of plan benefits, services and stay abreast of changes from year to year * ·Document and track actions requested from other departments addressing provider or member inquiries and informal complaints to insure prompt resolutions * Demonstrate effective use of departmental software and technical systems * Responsible for both incoming and outgoing provider phone initiatives. What we're looking for: * Education: High School diploma or equivalent required * Experience: 2-3 years of prior customer service experience required * Managed Care Industry knowledge or experience preferred * Ability to work independently with minimal supervision and also as a team. * Knowledge of and/or the ability to do data entry, various claim form formats, medical terminology, CPT and ICD9 coding Ministry/Facility Information: Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you're seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You! We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

This position is a full time temporary position. The position is to end 04/04/2026 **Why MediGold?** MediGold (********************** is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We're dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. **About the job:** Provider Service Specialist responds in a timely and accurate manner to provider inquiries made by phone, in person and in writing regarding Plan benefits, services and payment determinations. **What you'll do:** + Receive, interpret and accurately respond to provider inquiries, both verbally and in writing in accordance with department standards, policies and procedures. + Consistently document and accurately code all inquiries within designated software applications, within required Plan timeframes and according to Plan documentation policies + Review, investigate and advise providers regarding claims status and payment determinations + Maintain a comprehensive knowledge of plan benefits, services and stay abreast of changes from year to year + ·Document and track actions requested from other departments addressing provider or member inquiries and informal complaints to insure prompt resolutions + Demonstrate effective use of departmental software and technical systems + Responsible for both incoming and outgoing provider phone initiatives. **What we're looking for:** + Education: High School diploma or equivalent required + Experience: 2-3 years of prior customer service experience required + Managed Care Industry knowledge or experience preferred + Ability to work independently with minimal supervision and also as a team. + Knowledge of and/or the ability to do data entry, various claim form formats, medical terminology, CPT and ICD9 coding **Ministry/Facility Information:** Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you're seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You! We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. **Our Commitment** Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!Job Title:Authorization Specialist (Remote in Wisconsin/Michigan) Cost Center:101651135 Insurance VerificationScheduled Weekly Hours:40Employee Type:RegularWork Shift:Mon-Fri; day shifts (United States of America) Job Description: **Wisconsin and Michigan residents only eligible to apply** JOB SUMMARY The Authorization Specialist is a healthcare professional responsible for reviewing patient medical records to determine if a prescribed treatment, procedure, or medication requires prior authorization from the insurance company, ensuring that the requested care is deemed medically necessary and covered under the patient's benefits before it can be administered; this involves verifying patient eligibility, contacting insurance companies to obtain authorization, and managing the process to minimize delays in patient care. An Authorization Specialist works in a fast-paced environment with high call volumes, requiring strong organizational skills and the ability to manage multiple tasks simultaneously. JOB QUALIFICATIONS EDUCATION For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation. Minimum Required: None Preferred/Optional: Successful completion of post-secondary courses in Medical Terminology and Diagnosis and CPT Coding, and Anatomy & Physiology. Graduate of a Medical Assistant, Health Unit Coordinator or Health Care Business Service program. EXPERIENCE Minimum Required: Two years' experience in a medical business office or healthcare setting involving customer service or patient-facing responsibilities, or equivalent experience. In addition to the following: Medical knowledge: Understanding of basic medical terminology, disease processes, and treatment options to accurately assess medical necessity. Insurance knowledge: Familiarity with different insurance plans, benefit structures, and prior authorization guidelines. Excellent communication skills: Ability to effectively communicate with healthcare providers, insurance companies, and patients to clarify information and address concerns. Attention to detail: High level of accuracy in data entry and review of medical records to ensure correct prior authorization requests. Problem-solving skills: Ability to identify potential issues with prior authorization requests, navigate complex situations, and find solutions to ensure timely patient care. Preferred/Optional: None CERTIFICATIONS/LICENSES The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position. Minimum Required: None Preferred/Optional: None **Wisconsin and Michigan residents only eligible to apply** Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first. Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program. Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

Monday-Friday 8:30 a.m.-5pm No Weekends w/Holiday Rotations The Authorization Specialist is responsible and accountable for the processing of all THAH authorization documentation meeting HCFA/MCC/JCAHO regulations and guidelines. Primary responsibilities include processing all frontend documentation needed to meet third party payer authorization deadlines assuring accurate billing. In addition, monitors all accounts for ongoing authorization needs to ensure optimal reimbursement and compliance per agency policy. This position works closely with the THAH insurance team and THAH Collection analysts in the tracking of authorizations and resolution of problematic billing issues. Monitors pending authorizations report and collaborates with both the clinical and revenue cycle team to review and resolve pending claims to ensure timely payment. Duties may be accomplished in a remote work environment. What You Will Do: * Prepares and enters data into the appropriate software assuring the accuracy of the regulated client account following all regulations placed on the homecare agency. Ensures that input of information is accurate, and authorization is received timely for the submission of claims. Responds to all system issues by preparing documentation for the resolution center. Timely follow up on pending authorizations to ensure payment of claims. * Generates all authorization documentation needed to bill in a timely manner assuring industry standards are met. Monitors and processes the Subsequent Authorizations workflow and reports daily to assure timely and clean billing. * Utilizing the CQI Process Improvement technique, responsible for implementing and monitoring changes to processes to ensure continued integrity of client accounts. Collaborates with the Intake Department to identify processes for improvement ensuring the accuracy of the authorization process. * Provides statistical feedback regarding the status of unbilled claims due to authorizations to THAH Revenue team on a weekly basis or as defined by policy. * Interfaces with THAH to resolve problems related to the processing of bills/claims. Investigates client accounts and provides any additional documentation required. * Seeks assistance of Clinical Team Leaders and/or Revenue Cycle Leaders with clinical data entry and/or billing problems. * Coordinates the flow of billing related paperwork between the branch and THAH Service Center. Works with the branch and THAH colleagues to identify areas of improvement related to authorization workflow. Actively participates in all billing conference calls between the agency and THAH. * Acts independently and responsibly to perform duties on a consistent basis and in a timely manner. * Coordinates tracking system to monitor unbilled claims due to authorizations and utilizes appropriate monitoring reports available. * Acts as liaison between physician offices, THAH Service Center and the agency to assure timely billing with appropriate documentation. * Ensures that services provided support continuous quality improvement, customer-oriented focus, and quality client care outcomes. * The duties and responsibilities described are not a comprehensive list and additional tasks may be assigned from time to time, as the scope of the job may change as necessitated by business demands. Benefits: * Day 1 Benefits - Health, dental and vision insurance * Work Today Get Paid Tomorrow * Employee Referral Reward Program * Short and long-term disability * Tuition Reimbursement * Paid CEUs * 403b * Generous paid time off * Comprehensive orientation Minimum Qualifications: * The incumbent can articulate and demonstrate a commitment to the mission, vision, and values of Trinity Health and to inspire active support of these in others. * The preferred candidate will have a high school diploma or GED. * College business courses or an associate degree is preferred, or four to six years of experience in a medical billing office setting with a concentration on authorizations. * A strong knowledge of general business office functions, strong analytical and organizational skills and microcomputer usage is required. * Incumbent must possess the following: ability to meet strict deadlines with high level of accuracy, ability to prioritize multiple tasks in highly automated setting and possess strong interpersonal skills. * Ability to consistently demonstrate commitment to the mission and Organizational Code of Ethics and adhere to the Compliance. Apply Today!!!! Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

**Monday-Friday 8:30 a.m.-5pm No Weekends w/Holiday Rotations** The Authorization Specialist is responsible and accountable for the processing of all THAH authorization documentation meeting HCFA/MCC/JCAHO regulations and guidelines. Primary responsibilities include processing all frontend documentation needed to meet third party payer authorization deadlines assuring accurate billing. In addition, monitors all accounts for ongoing authorization needs to ensure optimal reimbursement and compliance per agency policy. This position works closely with the THAH insurance team and THAH Collection analysts in the tracking of authorizations and resolution of problematic billing issues. Monitors pending authorizations report and collaborates with both the clinical and revenue cycle team to review and resolve pending claims to ensure timely payment. Duties may be accomplished in a remote work environment. **What You Will Do:** + Prepares and enters data into the appropriate software assuring the accuracy of the regulated client account following all regulations placed on the homecare agency. Ensures that input of information is accurate, and authorization is received timely for the submission of claims. Responds to all system issues by preparing documentation for the resolution center. Timely follow up on pending authorizations to ensure payment of claims. + Generates all authorization documentation needed to bill in a timely manner assuring industry standards are met. Monitors and processes the Subsequent Authorizations workflow and reports daily to assure timely and clean billing. + Utilizing the CQI Process Improvement technique, responsible for implementing and monitoring changes to processes to ensure continued integrity of client accounts. Collaborates with the Intake Department to identify processes for improvement ensuring the accuracy of the authorization process. + Provides statistical feedback regarding the status of unbilled claims due to authorizations to THAH Revenue team on a weekly basis or as defined by policy. + Interfaces with THAH to resolve problems related to the processing of bills/claims. Investigates client accounts and provides any additional documentation required. + Seeks assistance of Clinical Team Leaders and/or Revenue Cycle Leaders with clinical data entry and/or billing problems. + Coordinates the flow of billing related paperwork between the branch and THAH Service Center. Works with the branch and THAH colleagues to identify areas of improvement related to authorization workflow. Actively participates in all billing conference calls between the agency and THAH. + Acts independently and responsibly to perform duties on a consistent basis and in a timely manner. + Coordinates tracking system to monitor unbilled claims due to authorizations and utilizes appropriate monitoring reports available. + Acts as liaison between physician offices, THAH Service Center and the agency to assure timely billing with appropriate documentation. + Ensures that services provided support continuous quality improvement, customer-oriented focus, and quality client care outcomes. + The duties and responsibilities described are not a comprehensive list and additional tasks may be assigned from time to time, as the scope of the job may change as necessitated by business demands. **Benefits:** + Day 1 Benefits - Health, dental and vision insurance + Work Today Get Paid Tomorrow + Employee Referral Reward Program + Short and long-term disability + Tuition Reimbursement + Paid CEUs + 403b + Generous paid time off + Comprehensive orientation **Minimum Qualifications:** + The incumbent can articulate and demonstrate a commitment to the mission, vision, and values of Trinity Health and to inspire active support of these in others. + The preferred candidate will have a high school diploma or GED. + College business courses or an associate degree is preferred, or four to six years of experience in a medical billing office setting with a concentration on authorizations. + A strong knowledge of general business office functions, strong analytical and organizational skills and microcomputer usage is required. + Incumbent must possess the following: ability to meet strict deadlines with high level of accuracy, ability to prioritize multiple tasks in highly automated setting and possess strong interpersonal skills. + Ability to consistently demonstrate commitment to the mission and Organizational Code of Ethics and adhere to the Compliance. **Apply Today!!!!** **Our Commitment** Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran

This position is a full time temporary position. The position is to end 04/04/2026 Why MediGold? MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We're dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. About the job: Provider Service Specialist responds in a timely and accurate manner to provider inquiries made by phone, in person and in writing regarding Plan benefits, services and payment determinations. What you'll do: * Receive, interpret and accurately respond to provider inquiries, both verbally and in writing in accordance with department standards, policies and procedures. * Consistently document and accurately code all inquiries within designated software applications, within required Plan timeframes and according to Plan documentation policies * Review, investigate and advise providers regarding claims status and payment determinations * Maintain a comprehensive knowledge of plan benefits, services and stay abreast of changes from year to year * ·Document and track actions requested from other departments addressing provider or member inquiries and informal complaints to insure prompt resolutions * Demonstrate effective use of departmental software and technical systems * Responsible for both incoming and outgoing provider phone initiatives. What we're looking for: * Education: High School diploma or equivalent required * Experience: 2-3 years of prior customer service experience required * Managed Care Industry knowledge or experience preferred * Ability to work independently with minimal supervision and also as a team. * Knowledge of and/or the ability to do data entry, various claim form formats, medical terminology, CPT and ICD9 coding Ministry/Facility Information: Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you're seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You! We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Phlebotomy Registration Specialist, Outpatient Lab, Day Shift The Phlebotomy Registration Specialist ensures accurate registration and ordering of patients presenting to the collections site. All information required for the completion of both test ordering and patient registration is collected. Places patient orders; collects and labels specimens utilizing positive patient identification. Processes and prepares specimens for transport as needed. Produces reports for faxing or delivery as needed and communicates appropriate information to the healthcare team. Registers patients in the appropriate systems. Responsibilities * Demonstrate friendliness, courtesy and effective communication to create a professional environment and provide first class service * Create a caring and healing environment that keeps the patient and family at the center of care * Collects specimens utilizing professional and accepted practices; labels specimens accurately * Responsible for ensuring all patient demographics and insurance information is complete in the hospital billing system to assure optimal data integrity throughout the registration process Minimum Qualifications * High school diploma or equivalent * Phlebotomy and basic computer skills required; Registration experience helpful * Effective Communication Skills * Ability to effectively function in stressful situations and perform multiple tasks * Ability to work a flexible schedule, as needed; must have reliable transportation to travel to various locations, including to but not limited to other offices and sites. This position will work 8-hour days shifts between the hours of 6:00 am - 6:00 pm; Monday - Friday. Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation, or physical ability. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

**Phlebotomy Registration Specialist, Outpatient Lab, Day Shift** The Phlebotomy Registration Specialist ensures accurate registration and ordering of patients presenting to the collections site. All information required for the completion of both test ordering and patient registration is collected. Places patient orders; collects and labels specimens utilizing positive patient identification. Processes and prepares specimens for transport as needed. Produces reports for faxing or delivery as needed and communicates appropriate information to the healthcare team. Registers patients in the appropriate systems. **Responsibilities** + Demonstrate friendliness, courtesy and effective communication to create a professional environment and provide first class service + Create a caring and healing environment that keeps the patient and family at the center of care + Collects specimens utilizing professional and accepted practices; labels specimens accurately + Responsible for ensuring all patient demographics and insurance information is complete in the hospital billing system to assure optimal data integrity throughout the registration process **Minimum Qualifications** + High school diploma or equivalent + Phlebotomy and basic computer skills required; Registration experience helpful + Effective Communication Skills + Ability to effectively function in stressful situations and perform multiple tasks + Ability to work a flexible schedule, as needed; must have reliable transportation to travel to various locations, including to but not limited to other offices and sites. **This position will work 8-hour days shifts between the hours of 6:00 am - 6:00 pm; Monday - Friday. Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation, or physical ability. **Our Commitment** Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran

Inspire health. Serve with compassion. Be the difference. Analyzes trends specific to denials, root cause, and accounts receivable impact. Resolves account issues or escalates as needed and documents billing activity on the patient accounts according to departmental and regulatory guidelines. This is a remote position Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Analyzes and articulates trends specific to denials, root cause, and A/R impact Completes and submits claims via electronic or paper claim submission according to governmental regulations, agency policies, Prisma Health guidelines and timeliness standards Contacts payer for inquiries on account status. Escalates account issues as needed and initiates the appeal process. Documents billing activity on the patient accounts according to departmental guidelines; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to departmental leaders. Properly documents accounts clearly with indicators and activities so that tracking and trending can be prepared for further analysis Adheres to policies and procedures as required by Prisma Health and follows all compliant regulatory payer guidance. Ensures all work is compliant with privacy, HIPAA, and regulatory requirements Knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist. Should be cross trained and proficient operate in any of these roles if the need arises. Performs other duties as required. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Education - High School diploma or equivalent OR post-high school diploma/highest degree earned Experience - Two (2) years billing, bookkeeping, accounting experience In Lieu Of NA Required Certifications, Registrations, Licenses NA Knowledge, Skills, and Abilities Knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist. Work Shift Day (United States of America) Location Independence Pointe Facility 7001 Corporate Department 70019122 PBO - Correspondence Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

Inspire health. Serve with compassion. Be the difference. Responsible for pursuing denied accounts, timely and accurate follow-up to address and improve resolution of payment delays, updating/reprocessing claims, submitting reconsiderations/appeals within proper filing timeframe to achieve optimal payment for services rendered. Denials and appeals specialists must be knowledgeable of payer requirements, experienced in claim resolution, identify, expedite and escalate trends to management, demonstrate exceptional relationships with external/internal payers as well as internal departments in accordance with Prisma Health Standard of Behaviors and Compliance.This is a remote position Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Responsible for resolution of denied claims and/or initiate/manage/follow-up on reconsiderations/appeals in a timely manner. - Monitors denial work queues and reports in accordance with assignments from direct supervisor and communicates all denial trends, denial increases, etc. to direct supervisor/PFS management in order to positively affect the volume of denials. Participates in departmental huddles and team meetings involving discussion of A/R processes and denial trends. Maintains required levels of productivity and quality while managing tasks in work queues to ensure timeliness of follow-up and appeals. Organizes denial/rejection related tasks to identify patterns and/or work most efficiently (e.g., by current procedural terminology, diagnosis, payer, etc.) Identifies and monitors negative patterns in denials/rejections. Escalates accordingly to PFS management and the impacted department(s) to avoid negative impact on reimbursement, unsuccessful appeals, and/or increased write-offs. Uses identified and known resources to accomplish follow-up on tasks. Identifies other means and resources to complete tasks, as applicable and appropriate. As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or PFS management. Comply with all government regulatory mandated requirements for billing and collections. Works with other departments to resolve A/R and payer issues. Communicates with other departments on issues that may have negative impact on their cash flow, timely claim reconsideration/filing, failed appeals, and/or increased denials and write-offs. Enters and documents appropriate accounts for adjustments utilizing the appropriate adjustment codes. Identifies and researches all payer issues to the Payer SharePoint in a timely manner and continues to follow-up on said SharePoint information on a weekly basis. Performs other duties as assigned. Supervisory/Management Responsibility This is a non-management job that will report to a supervisor, manager, director, or executive. Minimum Requirements Education - High School diploma or equivalent or post-high school diploma / highest degree earned Experience - Five (5) years hospital/physician billing office and/or healthcare revenue cycle experience In Lieu Of In lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: Bachelor's degree and two years of related work experience. Required Certifications, Registrations, Licenses Certified Revenue Cycle Analyst (CRCA) preferred Knowledge, Skills and Abilities Proficient computer skills (spreadsheets and excel pivot table skills) Data entry skills Mathematical skills Medical terminology/ICD Coding Knowledge of current trends and developments in the healthcare industry and specifically as it relates to denials/appeals through appropriate literature and professional development activities preferred Self-motivation and ability to demonstrate initiative, excellent time management skills, and organizational capabilities and must be able to multi-task in a fast-paced environment and appropriately handle overlapping commitments and deadlines preferred Ability to review/understand all pertinent information such as insurance carrier explanation of benefits, insurance carrier denial letters and electronic remits to ensure denials are worked in a timely manner and reconsideration/appeals for the denial claims are submitted appropriately preferred Comprehensive understanding of remittance and remark codes preferred Knowledge of payer edits, rejections, rules, and how to appropriately respond to each preferred Working knowledge of UB-04 claim forms preferred Work Shift Day (United States of America) Location Corporate Facility 7001 Corporate Department 70019122 PBO-Patient Account Services Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

**Purpose** (Pay Range: $24.5303-$36.7954) Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency. Responsible for auditing department information, producing reports, & suggesting improvements to processes. Provides knowledge & expertise in the program, services & applications. _Note: "patients" refers to patients, clients, residents, participants, customers, members_ **Essential Functions** **Our Trinity Health Culture:** Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. **Work Focus:** Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports. **Process Focus:** Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge. **Data Management & Analysis:** Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts. **Maintains a Working Knowledge** of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices. **Functional Role (not inclusive of titles or advancement career progression)** Responsible for ensuring accurate CPT and/or ICD-10 documentation for the patient billing process and educating colleagues and providers in accurately document services performed and using the appropriate codes representing those services. Maintains documentation regarding charge capture processes. Performs regular reviews of process adherence and identify missing charges. Coordinates with key stakeholders regarding impacts of system change requests and upgrades to processes to ensure capture accuracy. Provides oversight of charge reconciliation processes for assigned departments; ensuring daily and appropriate monthly reconciliations are occurring. Performs charge entry/capture functions, charge approvals, and/or quality charge reviews; including but not limited to, appending modifiers, and checking clinical documentation. Provides feedback to intra-departmental Revenue Integrity colleagues including areas of opportunity. Assist Nurse Auditor and/or other stakeholders with denial related charge reviews, including analysis of clinical documentation, root cause analysis and education to the responsible ancillary department. Performs daily reconciliation processes and/or provides "at-elbow support" to ancillary departments including but not limited to; ensuring supply charges are appropriate captured (may include implants), identify duplicate charges and initiate appropriate communications when there are documentation and/or charge deficiencies or charge errors. **Minimum Qualifications** + High school diploma or GED + Minimum three (3) years of relevant coding and charge control work experience in a hospital and/or Physician Practice environment and experience in revenue cycle, billing, coding and/or patient financial services. + Experience working with current clinical processes, charge master maintenance, clinical coding guidelines, charging processes and audits, and clinical billing as normally obtained through a bachelor's or associate degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field. + Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations. + Experience working with Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB). + Ability to perform charge capture processes, including understanding technical integration of electronic medical record and the automation of charge triggers, and ability to investigate charge errors accordingly. Epic experience desired. + Experience working with Hospital and/or Physician group practice revenue cycle front-end functions such as patient registration and provider payment enrollment and back-end functions that may impact charge related errors. **Additional Qualifications (nice to have)** + Licensure/Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials _and/or Licensed Vocational Nurse/ Licensed Practical Nurse licensure_ is required. CHC (Healthcare Compliance Certification) preferred. _CHRI_ certification/membership _strongly_ preferred. + Knowledge of clinical documentation improvement processes strongly preferred **Direct Healthcare Services:** + Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional + Lift a maximum of 30 pounds unassisted. Occasional + Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional + Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous + Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional + Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional **Indirect Healthcare / Support Services:** + Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional + Lift a maximum of 30 pounds unassisted. Occasional + Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional + Encounter a clinical / patient facing / hands on interactive work environment. Occasional + Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous + Work outdoors with variable external environmental conditions. Occasional _Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)_ **Our Commitment** Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran

Attached Purpose (Pay Range: $24.5303-$36.7954) Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency. Responsible for auditing department information, producing reports, & suggesting improvements to processes. Provides knowledge & expertise in the program, services & applications. Note: "patients" refers to patients, clients, residents, participants, customers, members Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports. Process Focus: Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge. Data Management & Analysis: Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts. Maintains a Working Knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices. Functional Role (not inclusive of titles or advancement career progression) Responsible for ensuring accurate CPT and/or ICD-10 documentation for the patient billing process and educating colleagues and providers in accurately document services performed and using the appropriate codes representing those services. Maintains documentation regarding charge capture processes. Performs regular reviews of process adherence and identify missing charges. Coordinates with key stakeholders regarding impacts of system change requests and upgrades to processes to ensure capture accuracy. Provides oversight of charge reconciliation processes for assigned departments; ensuring daily and appropriate monthly reconciliations are occurring. Performs charge entry/capture functions, charge approvals, and/or quality charge reviews; including but not limited to, appending modifiers, and checking clinical documentation. Provides feedback to intra-departmental Revenue Integrity colleagues including areas of opportunity. Assist Nurse Auditor and/or other stakeholders with denial related charge reviews, including analysis of clinical documentation, root cause analysis and education to the responsible ancillary department. Performs daily reconciliation processes and/or provides "at-elbow support" to ancillary departments including but not limited to; ensuring supply charges are appropriate captured (may include implants), identify duplicate charges and initiate appropriate communications when there are documentation and/or charge deficiencies or charge errors. Minimum Qualifications * High school diploma or GED * Minimum three (3) years of relevant coding and charge control work experience in a hospital and/or Physician Practice environment and experience in revenue cycle, billing, coding and/or patient financial services. * Experience working with current clinical processes, charge master maintenance, clinical coding guidelines, charging processes and audits, and clinical billing as normally obtained through a bachelor's or associate degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field. * Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations. * Experience working with Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB). * Ability to perform charge capture processes, including understanding technical integration of electronic medical record and the automation of charge triggers, and ability to investigate charge errors accordingly. Epic experience desired. * Experience working with Hospital and/or Physician group practice revenue cycle front-end functions such as patient registration and provider payment enrollment and back-end functions that may impact charge related errors. Additional Qualifications (nice to have) * Licensure/Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials and/or Licensed Vocational Nurse/ Licensed Practical Nurse licensure is required. CHC (Healthcare Compliance Certification) prefered CHRI certification/membership strongly preferred. * Knowledge of clinical documentation improvement processes strongly preferred Physical & Mental Requirements & Working Conditions (General Summary) Direct Healthcare Services / Indirect Healthcare / Support Services: * Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional * Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional * Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional * Exposure to interruptions, shifting priorities & stressful situations. Frequent * Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Frequent * Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent * Perform manual dexterity activities & / or grasping / handling. Continuous * Ability to climb, kneel, crouch & / or operate foot controls. Occasional * Use a computer / other technology. Frequent * Sit with the ability to vary / adjust physical position or activity. Frequent * Maintain a safe working environment & use available personal protective equipment (PPE). Continuous * Comply with Trinity Health's Code of Conduct, policies, procedures & guidelines. Continuous * Ability to provide assistance in the event of an emergency. Occasional Direct Healthcare Services: * Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional * Lift a maximum of 30 pounds unassisted. Occasional * Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional * Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous * Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional * Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional Indirect Healthcare / Support Services: * Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional * Lift a maximum of 30 pounds unassisted. Occasional * Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional * Encounter a clinical / patient facing / hands on interactive work environment. Occasional * Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous * Work outdoors with variable external environmental conditions. Occasional Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%) Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Attached **Purpose** (Pay Range: $24.5303-$36.7954) Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency. Responsible for auditing department information, producing reports, & suggesting improvements to processes. Provides knowledge & expertise in the program, services & applications. _Note: "patients" refers to patients, clients, residents, participants, customers, members_ **Essential Functions** **Our Trinity Health Culture:** Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. **Work Focus:** Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports. **Process Focus:** Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge. **Data Management & Analysis:** Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts. **Maintains a Working Knowledge** of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices. **Functional Role (not inclusive of titles or advancement career progression)** Responsible for ensuring accurate CPT and/or ICD-10 documentation for the patient billing process and educating colleagues and providers in accurately document services performed and using the appropriate codes representing those services. Maintains documentation regarding charge capture processes. Performs regular reviews of process adherence and identify missing charges. Coordinates with key stakeholders regarding impacts of system change requests and upgrades to processes to ensure capture accuracy. Provides oversight of charge reconciliation processes for assigned departments; ensuring daily and appropriate monthly reconciliations are occurring. Performs charge entry/capture functions, charge approvals, and/or quality charge reviews; including but not limited to, appending modifiers, and checking clinical documentation. Provides feedback to intra-departmental Revenue Integrity colleagues including areas of opportunity. Assist Nurse Auditor and/or other stakeholders with denial related charge reviews, including analysis of clinical documentation, root cause analysis and education to the responsible ancillary department. Performs daily reconciliation processes and/or provides "at-elbow support" to ancillary departments including but not limited to; ensuring supply charges are appropriate captured (may include implants), identify duplicate charges and initiate appropriate communications when there are documentation and/or charge deficiencies or charge errors. **Minimum Qualifications** + High school diploma or GED + Minimum three (3) years of relevant coding and charge control work experience in a hospital and/or Physician Practice environment and experience in revenue cycle, billing, coding and/or patient financial services. + Experience working with current clinical processes, charge master maintenance, clinical coding guidelines, charging processes and audits, and clinical billing as normally obtained through a bachelor's or associate degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field. + Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations. + Experience working with Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB). + Ability to perform charge capture processes, including understanding technical integration of electronic medical record and the automation of charge triggers, and ability to investigate charge errors accordingly. Epic experience desired. + Experience working with Hospital and/or Physician group practice revenue cycle front-end functions such as patient registration and provider payment enrollment and back-end functions that may impact charge related errors. **Additional Qualifications (nice to have)** + Licensure/Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials _and/or Licensed Vocational Nurse/ Licensed Practical Nurse licensure_ is required. CHC (Healthcare Compliance Certification) prefered _CHRI_ certification/membership _strongly_ preferred. + Knowledge of clinical documentation improvement processes strongly preferred **Physical & Mental Requirements & Working** **Conditions (General Summary)** **Direct Healthcare Services / Indirect Healthcare / Support Services:** + Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional + Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional + Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional + Exposure to interruptions, shifting priorities & stressful situations. Frequent + Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Frequent + Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent + Perform manual dexterity activities & / or grasping / handling. Continuous + Ability to climb, kneel, crouch & / or operate foot controls. Occasional + Use a computer / other technology. Frequent + Sit with the ability to vary / adjust physical position or activity. Frequent + Maintain a safe working environment & use available personal protective equipment (PPE). Continuous + Comply with Trinity Health's Code of Conduct, policies, procedures & guidelines. Continuous + Ability to provide assistance in the event of an emergency. Occasional **Direct Healthcare Services:** + Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional + Lift a maximum of 30 pounds unassisted. Occasional + Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional + Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous + Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional + Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional **Indirect Healthcare / Support Services:** + Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional + Lift a maximum of 30 pounds unassisted. Occasional + Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional + Encounter a clinical / patient facing / hands on interactive work environment. Occasional + Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous + Work outdoors with variable external environmental conditions. Occasional _Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)_ **Our Commitment** Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Work Shift: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40Salary Range: $15.00 - $22.00 Union Position: No Department Details This is a fully remote position within a supportive, collaborative team and a rapidly growing program. You'll have the opportunity to contribute to shaping processes, expand your skills, and make a meaningful impact while enjoying the flexibility of remote work. Summary Greatly contributes to the success of integrated primary care ensuring overall quality patient care through prevention and wellness strategies. Supports a clinic by managing and coordinating care for their panel of patients. Monitor attribution, identify gaps in care, coordinate preventative services, and make outreach to patients or health care providers to ensure coordination of care. Ensure patient's needs are being met by connecting to appropriate and available services, care team members, and resources to promote optimal health and wellbeing. Job Description Assists the clinic care team in managing and coordinating preventative screenings and wellness strategies for optimal health and wellbeing. Provides oversight to provider's patient panels by monitoring patient attribution contributing to integrity of the EMR, coordinating wellness screenings for specific specialties, supporting office visit, procedure, and scheduling screenings as appropriate, and managing the appropriate chronic disease registries, provider score cards, and result reconciliation. Promotes quality initiatives and improved patient outcomes. Participates in care for age related patients in all phases of preventative care and health maintenance. Functions within the administration pre-defined scope of practice guidelines. Track and report quality measures and validate accuracy and integrity of patient records. Participates in the care of patients by collecting subjective and objective data from the patient or caregiver to identify potential barriers to care (SDoH) and refers to care management roles as appropriate. Communicates collected data and obtains appropriate orders to support the health care team and follows through on the patient's plan of care under the direction of the care team. Demonstrates computer literacy including using Microsoft Office products and electronic health record (EHR). High level of computer skills and ability to run registries. Demonstrates experience and professionalism in the following skills, but not limited to: customer service, critical thinking, multi-tasking, medical and medication terminology, and medical paperwork knowledge including insurance completion/submission requirements. Qualifications Post secondary education of one - two years, with an emphasis in healthcare or medical related field is preferred. A minimum of one year work experience in ambulatory care, community outreach, patient or provider support, customer service, and/or various integrated care systems preferred. Training in Motivational Interviewing and/or Mental Health First Aid preferred. Background as a Certified Medical Assistant (CMA) is preferred. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call ************** or send an email to ************************.

Trinity Health, Mid-Atlantic, is looking for an Insurance Verification Specialist to join our team! Employment Type: Per Diem - Day need Shift: 20hrs/month, per department needs. Remote opportunity. : The Insurance Verification Specialist will be responsible for ensuring all pre-service accounts are financially cleared prior to the date of service for the Trinity Mid-Atlantic Region which includes, Mercy Fitzgerald, Nazareth Hospital, St. Francis Wilmington and St. Mary Medical Center Langhorne. * Responsible for complex, high-dollar services including surgical, observation and in-house services working in multiple areas of verification including outpatient verification, elective short procedure / inpatient verification, & urgent admission verification or scheduling. * Obtains and verifies accurate insurance information, benefit validation, authorization, and preservice collections. * Begins the overall patient experience and initiates the billing process for any services provided by the hospital. Minimum Qualifications: * High School Diploma or equivalent. * Two (2) to Five (5) years experience in area of expertise such as scheduling, financial clearance, or patient access. * National certification in HFMA CRCR or NAHAM CHAA required within one (1) year of hire. * Must be proficient in the use of Patient Registration/Patient Accounting systems and related software systems. Additional Qualifications (nice to have): * Associates Degree, preferred. * Comprehensive knowledge of scheduling with mastery in at least three (3) or more modalities and insurance verification processes with three (3) years scheduling experience in an acute care setting. * Experience in complex facility based ancillary testing across multiple facilities/states. * Strong knowledge of third-party and government payer billing and reimbursement guidelines as well as department performance standards and policies and procedures. We offer a competitive salary and comprehensive benefits including: * Medical, Dental, & Vision Coverage * Retirement Savings Program * Paid Time Off * DailyPay * Tuition Reimbursement * Free Parking * And more! Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

**_Trinity Health, Mid-Atlantic, is looking for an Insurance Verification Specialist to join our team!_** **Employment Type** : Per Diem - Day need **Shift:** 20hrs/month, per department needs. Remote opportunity. **:** The Insurance Verification Specialist will be responsible for ensuring all pre-service accounts are financially cleared prior to the date of service for the Trinity Mid-Atlantic Region which includes, Mercy Fitzgerald, Nazareth Hospital, St. Francis Wilmington and St. Mary Medical Center Langhorne. + Responsible for complex, high-dollar services including surgical, observation and in-house services working in multiple areas of verification including outpatient verification, elective short procedure / inpatient verification, & urgent admission verification or scheduling. + Obtains and verifies accurate insurance information, benefit validation, authorization, and preservice collections. + Begins the overall patient experience and initiates the billing process for any services provided by the hospital. **Minimum Qualifications:** + High School Diploma or equivalent. + Two (2) to Five (5) years experience in area of expertise such as scheduling, financial clearance, or patient access. + National certification in HFMA CRCR or NAHAM CHAA required within one (1) year of hire. + Must be proficient in the use of Patient Registration/Patient Accounting systems and related software systems. **Additional Qualifications (nice to have):** + Associates Degree, preferred. + Comprehensive knowledge of scheduling with mastery in at least three (3) or more modalities and insurance verification processes with three (3) years scheduling experience in an acute care setting. + Experience in complex facility based ancillary testing across multiple facilities/states. + Strong knowledge of third-party and government payer billing and reimbursement guidelines as well as department performance standards and policies and procedures. **We offer a competitive salary and comprehensive benefits including:** + Medical, Dental, & Vision Coverage + Retirement Savings Program + Paid Time Off + DailyPay + Tuition Reimbursement + Free Parking + And more! **Our Commitment** Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran

Saint Alphonsus Health System is hiring for our Financial Clearance team. This position is full-time working office hours (Monday-Friday). The Financial Clearance Specialist obtains and/or verifies demographic, clinical, financial and insurance information in the process of pre-registering and financially clearing patients for service delivery, including the entry of patient/guarantor information in the patient accounting system. The Pre-Service Specialist is also responsible for insurance eligibility / benefit verification, pre-certification / authorization, referral clearance and financial education on designated cases. Our ideal candidate has experience with EPIC, has worked in healthcare, and is local to the Treasure Valley in Idaho. Position Highlights and Benefits: * 40 hours per week Monday - Friday during traditional office hours * Position is remote (work from home); however, there is required in-person training during initial orientation in Boise, ID. Minimum Qualifications: * High school diploma or equivalent required. Associate degree preferred. * Required: At least two (2) years of experience in financial clearance. * National certification in HFMA CRCR or NAHAM CHAA required within one (1) year of hire. * Must be proficient in the use of Patient Registration/Patient Accounting systems and related software systems. Ideal Candidate will have: * Comprehensive knowledge of financial clearance and insurance verification processes with at least two (2) years of financial clearance experience in an acute care setting. * Past work experience of at least 2 years within healthcare and/or payer environment performing patient access and/or customer service activities. * Preferred: Data entry skills (50-60 keystrokes per minute). What You Will Do: * Work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Excellent problem-solving skills are essential. * Ensures patient safety by authenticating patient identity throughout all essential functions. * Meets or exceeds established customer service, productivity and quality standards in all essential functions. * Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence. * Performs activities that relate to pre-registration and financial clearance for multiple patient types and support coverage of other departmental divisions. * Responsible for pre-registering the patient for upcoming visit(s). Validates, obtains and enters demographic, clinical, financial, and insurance information into the patient accounting system. * Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms and documenting information within the patient accounting system. * Determines need for appropriate service authorizations and will contact the physician and Case Management/Utilization Review personnel, as necessary. * Informs patient/guarantor of their liabilities and collects appropriate patient liabilities. Calculates patient liabilities and provides financial education, referring the patient to financial counseling, as required. * Validates medical necessity (LCD/NCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. * May serve as relief support, if the work schedule or workload demands assistance to departmental personnel. May also be chosen to serve as a resource to train new employees. * Must be able to sit or stand for extended periods of time and use a telephone headset. * Completion of regulatory/mandatory certifications and skills validation competencies preferred * Working knowledge of medical terminology desirable. Basic computer skills are required. * Excellent communication (verbal and written) and organizational abilities. * Must be comfortable operating in a collaborative, shared leadership environment. * Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health. Highlights and Benefits: When Saint Alphonsus takes care of you, you can take better care of our patients. We foster personal and professional growth and offer opportunities that empower our colleagues to develop their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho and Oregon. * We offer market-competitive pay, generous PTO, and multiple options for comprehensive benefits that begin on day one. * Benefits for your future include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs develop. * We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow. Visit ****************************** to learn more! Ministry/Facility Information: Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 73 clinic locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus' goal is to improve the health and well-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based. * Top 15 Health Systems in the country by IBM Watson Health; * The region's most advanced Trauma Center (Level II); * Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and quality of life. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Employment Type:Full time Shift:Day ShiftDescription: Saint Alphonsus Health System is hiring for our Financial Clearance team. This position is full-time working office hours (Monday-Friday). The Financial Clearance Specialist obtains and/or verifies demographic, clinical, financial and insurance information in the process of pre-registering and financially clearing patients for service delivery, including the entry of patient/guarantor information in the patient accounting system. The Pre-Service Specialist is also responsible for insurance eligibility / benefit verification, pre-certification / authorization, referral clearance and financial education on designated cases. Our ideal candidate has experience with EPIC, has worked in healthcare, and is local to the Treasure Valley in Idaho. Position Highlights and Benefits: 40 hours per week Monday - Friday during traditional office hours Position is remote (work from home); however, there is required in-person training during initial orientation in Boise, ID. Minimum Qualifications: High school diploma or equivalent required. Associate degree preferred. Required: At least two (2) years of experience in financial clearance. National certification in HFMA CRCR or NAHAM CHAA required within one (1) year of hire. Must be proficient in the use of Patient Registration/Patient Accounting systems and related software systems. Ideal Candidate will have: Comprehensive knowledge of financial clearance and insurance verification processes with at least two (2) years of financial clearance experience in an acute care setting. Past work experience of at least 2 years within healthcare and/or payer environment performing patient access and/or customer service activities. Preferred: Data entry skills (50-60 keystrokes per minute). What You Will Do: Work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Excellent problem-solving skills are essential. Ensures patient safety by authenticating patient identity throughout all essential functions. Meets or exceeds established customer service, productivity and quality standards in all essential functions. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence. Performs activities that relate to pre-registration and financial clearance for multiple patient types and support coverage of other departmental divisions. Responsible for pre-registering the patient for upcoming visit(s). Validates, obtains and enters demographic, clinical, financial, and insurance information into the patient accounting system. Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms and documenting information within the patient accounting system. Determines need for appropriate service authorizations and will contact the physician and Case Management/Utilization Review personnel, as necessary. Informs patient/guarantor of their liabilities and collects appropriate patient liabilities. Calculates patient liabilities and provides financial education, referring the patient to financial counseling, as required. Validates medical necessity (LCD/NCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. May serve as relief support, if the work schedule or workload demands assistance to departmental personnel. May also be chosen to serve as a resource to train new employees. Must be able to sit or stand for extended periods of time and use a telephone headset. Completion of regulatory/mandatory certifications and skills validation competencies preferred Working knowledge of medical terminology desirable. Basic computer skills are required. Excellent communication (verbal and written) and organizational abilities. Must be comfortable operating in a collaborative, shared leadership environment. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health. Highlights and Benefits: When Saint Alphonsus takes care of you, you can take better care of our patients. We foster personal and professional growth and offer opportunities that empower our colleagues to develop their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho and Oregon. We offer market-competitive pay, generous PTO, and multiple options for comprehensive benefits that begin on day one. Benefits for your future include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs develop. We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow. Visit ****************************** to learn more! Ministry/Facility Information: Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 73 clinic locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus' goal is to improve the health and well-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based. Top 15 Health Systems in the country by IBM Watson Health; The region's most advanced Trauma Center (Level II); Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and quality of life. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Saint Alphonsus Health System is hiring for our Financial Clearance team. This position is full-time working office hours (Monday-Friday). The Financial Clearance Specialist obtains and/or verifies demographic, clinical, financial and insurance information in the process of pre-registering and financially clearing patients for service delivery, including the entry of patient/guarantor information in the patient accounting system. The Pre-Service Specialist is also responsible for insurance eligibility / benefit verification, pre-certification / authorization, referral clearance and financial education on designated cases. Our ideal candidate has experience with EPIC, has worked in healthcare, and is local to the Treasure Valley in Idaho. **Position Highlights and Benefits:** + 40 hours per week Monday - Friday during traditional office hours + Position is remote (work from home); however, there is required **in-person training** during initial orientation in Boise, ID. **Minimum Qualifications:** + High school diploma or equivalent required. Associate degree preferred. + Required: At least two (2) years of experience in financial clearance. + National certification in HFMA CRCR or NAHAM CHAA required within one (1) year of hire. + Must be proficient in the use of Patient Registration/Patient Accounting systems and related software systems.Ideal Candidate will have: + Comprehensive knowledge of financial clearance and insurance verification processes with at least two (2) years of financial clearance experience in an acute care setting. + Past work experience of at least 2 years within healthcare and/or payer environment performing patient access and/or customer service activities. + Preferred: Data entry skills (50-60 keystrokes per minute). **What You Will Do:** + Work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Excellent problem-solving skills are essential. + Ensures patient safety by authenticating patient identity throughout all essential functions. + Meets or exceeds established customer service, productivity and quality standards in all essential functions. + Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence. + Performs activities that relate to pre-registration and financial clearance for multiple patient types and support coverage of other departmental divisions. + Responsible for pre-registering the patient for upcoming visit(s). Validates, obtains and enters demographic, clinical, financial, and insurance information into the patient accounting system. + Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms and documenting information within the patient accounting system. + Determines need for appropriate service authorizations and will contact the physician and Case Management/Utilization Review personnel, as necessary. + Informs patient/guarantor of their liabilities and collects appropriate patient liabilities. Calculates patient liabilities and provides financial education, referring the patient to financial counseling, as required. + Validates medical necessity (LCD/NCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. + May serve as relief support, if the work schedule or workload demands assistance to departmental personnel. May also be chosen to serve as a resource to train new employees. + Must be able to sit or stand for extended periods of time and use a telephone headset. + Completion of regulatory/mandatory certifications and skills validation competencies preferred + Working knowledge of medical terminology desirable. Basic computer skills are required. + Excellent communication (verbal and written) and organizational abilities. + Must be comfortable operating in a collaborative, shared leadership environment. + Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health. **Highlights and Benefits:** When Saint Alphonsus takes care of you, you can take better care of our patients. We foster personal and professional growth and offer opportunities that empower our colleagues to develop their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho and Oregon. + We offer market-competitive pay, generous PTO, and multiple options for comprehensive benefits that begin on day one. + Benefits for your future include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs develop. + We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow. **Visit** ****************************** (**************************************************************************************************** **to learn more!** **Ministry/Facility Information:** Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 73 clinic locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus' goal is to improve the health and well-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based. + Top 15 Health Systems in the country by IBM Watson Health; + The region's most advanced Trauma Center (Level II); + Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and quality of life. **Our Commitment** Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran