Denver Health

Medical Billing and Coding

• Review medical record documentation to abstract and assign diagnoses, procedures, and modifiers
• Provide feedback regarding documentation and coding issues
• Maintain understanding of and ensure compliance with all applicable Official Coding Guidelines
• Participate in coder and provider education including documentation improvement efforts for providers
• Interact with provider, nursing staff and departments as assigned
• Assist in the training and quality assurance of all coding levels
• Strive for strong unit cohesion by working well with other members of the team

DRG Coder IV

Bilingual

• Under minimal supervision, the clinical specialist pharmacist is responsible for reviewing and approving medications, providing drug therapy management services for patients in assigned area, and provision of pharmacy services, including drug information, patient education, and patient monitoring.
• Initiate, adjust, and monitor medications pursuant to provider order and consistent with department policy, and rules and regulations promulgated by state and federal laws and The Joint Commission.
• The clinical specialist pharmacist is the subject matter expert in a specialized pharmacy area and collaborates with pharmacy leadership in development of policies and procedures, clinical care guidelines, and other work required to effectively provide high quality pharmaceutical care.
• Interprets and clarifies orders for all types of medications.
• Researches and responds promptly to drug information requests.
• In collaboration with providers, monitors drug therapies for appropriateness and formulary adherence, ensuring drug regimen supports financial stewardship.
• Designs therapeutic drug regimens or plans based on patient-specific information that includes establishing a therapeutic endpoint, selecting appropriate drug and related therapy, and establishing an appropriate dosing regimen.
• Monitors drug therapy for potential drug-drug, drug-food, and drug-disease interactions.
• Advises patients, family and medical staff on use of various medications including dosage, side effects, drug interactions and composition.
• Directly supervises the work of pharmacy technicians and support staff as required by the Colorado Board of Pharmacy
• Prepares or oversees the compounding, labeling and packaging of sterile or non-sterile medications, products and pharmaceuticals in accordance with all regulatory requirements as applicable.
• Maintains secure storage and records of all medications in accordance with manufacturer, state and federal requirements.

Clinical Pharmacist, bilingual preferred – Spanish

Accountant

• Prepares and analyzes monthly financial statement and reports.
• Performs data preparation and journal entries supporting month end close process
• Analyzes and verifies data to reconcile accounting transactions; posting adjustments.
• Cash Book management and reconciliation; daily posting of cash transaction and month end closing of Cash module and reconciliation of Bank accounts.
• Audits and proofs reports to verify accounting information.
• Communicates accounting transaction requirements to other departments to establish quality accounting processing standards; explains procedures.
• Reviews general ledger (G/L) activity regarding receivable and payables to ensure all activity is properly recorded.
• Verifies accounts by reconciling transactions; investigating and resolving discrepancies.
• Identifies and remediates process inefficiencies by partnering with groups across the Finance and related business and operation areas.
• Analyzes balance sheet and variance for assigned accounts.
• Prepares required reports and financials for external audit and addresses audit queries.

Lead Accountant

• Reviews medical record documentation to abstract and assign diagnoses, procedures, and modifiers for statistical classification and reimbursement purposes.
• Performs various coding assignments under the direction of Coding Management.
• Provides feedback regarding documentation and coding issues.
• Utilizes software applications and coding references to perform coding related tasks.
• Assists in training, mentoring, and quality assurance of Level I and Level II coders as directed by Coding Management.
• Interacts with clinical departments as needed.
• Strives for strong unit cohesion by working well with other members of the team.

Facility Coder III

Business Intelligence Analyst

• Engage with business stakeholders, project managers, application analysts, and vendors in the design, build, and maintenance of information management solutions.
• Coordinate data and reporting needs between the user community and Managed Care systems.
• Document customer's requirements and translate them into technical requirements, data analysis, and reports.
• Utilize strong understanding of statistical modeling to perform data analysis.
• Support the analytics and reporting regarding strategic programs including HEDIS, Medicare Stars, quality of care, and other managed care subject areas.
• Gather requirements for internal reports and analysis, as well as external vendor data extracts.
• Translates requirements into report/extract designs.
• Evaluates data sources and technical approaches to satisfy user requirements.
• Gains understanding of the source data’s meaning, accuracy, and completeness and how it may affect the report/extract design and business outcomes.
• Documents the solution to include tech specifications, data mappings, and other design documents to be maintained in a common repository.
• Codes the solution to meet the agreed upon specifications and performs unit testing of the product.
• Maintains regular communication with end users on design implications, timeline, and solution outcomes.
• Coordinates with end-users on the validation and acceptance of the final work product.
• Ensures solution is properly tested and promoted to production following standard change management practices.
• Creates, maintains, and monitors associated job schedules.
• Participates as needed in the planning, scoping, design, and delivery of project components that are information management specific deliverables.
• Coordinates with business owners, vendors, and project leadership to ensure timelines and outcomes are met.
• Advises project teams on issues and needs as they arise that may affect the project outcomes, making recommendations to address the stated concerns.
• Supports the process of assigning, managing and re-prioritizing project priorities as needed.
• Provides project updates, status, estimates to complete, etc. to support project outcomes.
• Provides technical and administrative support to maintain and administer the BI reporting portal and BI reporting tools.
• Oversees the BI reporting change management process.

Senior Business Intelligence Specialty Analyst

QA Engineer

• The Quality Improvement (QI) Specialist supports the design, implementation, and evaluation of quality initiatives that enhance member outcomes, strengthen provider performance, and ensure compliance with regulatory requirements.
• Collaborates with cross-functional teams and external stakeholders to drive measurable improvements in clinical care, operational processes, and member experience.
• Ensure compliance with HCPF quality requirements, including performance improvement projects (PIPs), External Quality Review Organization (EQRO) reporting, and population health initiatives.
• Support National Committee for Quality Assurance: (NCQA) accreditation readiness and regulatory audits by maintaining accurate documentation and work plans.
• Partner with care management, pharmacy, and provider networks to design and implement quality interventions that improve outcomes and reduce disparities.
• Apply quality improvement methodologies (e.g., PDSA, Lean, Six Sigma) to evaluate workflows, streamline processes, and enhance operational efficiency.
• Collect and analyze feedback (CAHPS, surveys, advisory groups) to inform strategies that improve access, coordination, and satisfaction.
• Develop dashboards, reports, and presentations for leadership, committees, and external stakeholders, ensuring accuracy and timeliness.
• Facilitate or support quality committees, workgroups, and cross-departmental projects focused on clinical and operational improvement.

Quality Improvement Specialist – NCQA

Analyst

• Under general supervision reviews, evaluates and conducts training and monitoring programs for Denver Health Medical Plan (DHMP) to ensure the training and monitoring needs of Managed Care are being fulfilled.
• Coordinate with an array of teams and assess monitoring needs based on training, regulations and operational needs.
• In alignment with monitoring, develop standard work, policies and training to meet operational requirements.
• Analyzes existing training program delivery, content, and aids to measure effectiveness and recommend program changes.
• Develops and recommends methods and materials in order to train staff.
• Develops, performs and evaluates new hire and ongoing training of DHMP Staff as needed.
• Work with Managed Care teams to identify operational monitoring needs and develop monitoring plans.
• Work with Managed Care teams to identify operational training needs and develop training plans.
• Conduct operational monitoring on a regular basis and report out on issues identified.
• Form findings in operational monitoring identify additional training needs.
• Documents all identified issues in standard format and provide a regular summary of operation monitoring findings for team leaders.
• Design and conduct training for new hires and ongoing training based on identified needs.
• Identify how operational monitoring and training works between teams in addition to the individual teams.
• Proposes recommendations for continuous improvement within and between Managed Care teams.
• Maintains knowledge of current regulatory standards, internal policies, and procedures and ensures compliance at all times.
• Maintains knowledge and information on contract terms and benefit plans for all Plan lines of business.
• Develops and executes appropriate communication strategies to ensure workflow success.
• Promotes positive interpersonal relationships with fellow employees, providers, physicians, patients, health plan members and visitors.
• Consistently displays courteous and respectful verbal and non-verbal communication.
• Acts as a role model and leader for team relations within Managed Care.
• Maintains positive behaviors, attitudes, and commitment to day-to-day activities and work efforts.
• Manages workload in accordance with identified priorities and makes recommendations in modifying deadlines as needed.
• Prioritizes daily workflow to ensure successful completion of activities and non-project oriented commitments.
• Identifies and notifies all potential or suspected issues involving fraud, waste, and abuse to the Director of Managed Care Compliance.
• Ensures confidentiality of patient information by creating and maintaining a secure and trusting environment by not sharing information learned on the job, except when necessary in the performance of the job responsibilities or to improve a patient’s care.

Health Plan Trainer, Analyst

Call Center Representative

• Under close supervision, serves customers by answering incoming calls utilizing Denver Health and Departmental policies/processes to resolve customer requests and directing calls to the appropriate area when necessary.
• Responsible for effectively screening/identifying customer requirements and taking appropriate action based on this information.
• Provides assistance to Denver Health staff by collecting demographic, medical complaint and key information required to facilitate appropriate patient care and call resolution.
• Completes computerized patient scheduling, collection of comprehensive demographic and insurance information required to facilitate timely and accurate billing of services, obtainment of pre certification authorization and benefit information necessary for payment.
• Answers all calls in a courteous, respectful and helpful manner utilizing interpretation services to facilitate customer communications; performs information lookups using all sources of data to provide rapid, accurate call resolution.
• Fulfills internal and external customer requests by clarifying desired information, utilizing Denver Health resources to complete transactions, forwarding requests when appropriate.
• Understands standardized scheduling, rescheduling, and cancellation guidelines. Schedules to appropriate provider according to patient request, provider direction, and availability according to preset approved scheduling guidelines.
• Maintains continuity of work operations by documenting and communicating actions, completes activity reports and communications upon request for various Departmental functions and initiatives; keeps equipment operational by following established procedures and reporting malfunctions.
• Determines requirements by working with customers; answers inquiries by clarifying desired information, researching, locating and providing information; taking action based on this information either to resolve the customer’s request or transfer appropriately.
• Resolves customer problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
• Educates customers on additional services by recognizing opportunities to enhance the customers experience and meet their needs; informs and guides patients to resources.
• Proficient in gathering, verifying and updating demographic, financial, guarantor, insurance and patient information for new and existing patients within the practice management/electronic health record and various Denver Health computer applications.

Scheduler I, Call Center

Director

• Leads the strategic vision and operational execution of pharmacy benefits ensuring alignment with clinical excellence, financial sustainability, and member centric outcomes.
• Manages end-to-end pharmacy benefit design, oversight, and performance management across the entire health plan ecosystem from formulary strategy and Pharmacy Benefit Manager (PBM) partnership to member experience and quality improvement.
• Drives optimization of medication access, adherence and cost savings.
• Reviews, analyzes and monitor pharmacy cost and utilization data to inform and execute on short-term and long-term business goals.
• Provides strategic oversight of all pharmacy functions, including Pharmacy Benefit Manager (PBM) performance, formulary strategy, benefit design, and cost containment.
• Oversees formulary management and 340B program strategy, including specialty drug utilization, biosimilar uptake, opioid safety, and behavioral health pharmacy integration.
• Designs and implement pharmacy financial incentive programs, such as prescriber performance bonuses, shared savings models tied to utilization efficiency, outcomes-based rebate innovation, and value-tiered network designs to improve access and affordability.
• Provides oversight of the Pharmacy & Therapeutics (P&T) Committee, ensuring formulary governance, clinical alignment, and rapid adoption/evaluation of emerging therapies.
• Negotiates and manages PBM contract with explicit quality and performance targets, ensuring alignment with health plan clinical, regulatory, and cost-saving objectives.
• Development and implementation of strategies for the evaluation, performance and enhancement of current and new pharmacy programs including Medication Adherence Programs and Disease Management.
• Prepares and presents monthly, quarterly, annual and ad-hoc reports upon request.

Director, Pharmacy

• Reviews medical record documentation to abstract and assign diagnoses, procedures, and modifiers for statistical classification and reimbursement purposes.
• Provides feedback regarding documentation and coding issues.
• Utilizes software applications and coding references, including electronic, to perform coding related tasks.
• Maintains an understanding of and ensures compliance with, all applicable coding guidelines.
• Meets or exceeds the minimum coding productivity standard for the type of coding performed.
• Meets or exceeds the minimum coding accuracy rate of 95%.
• Completes required coding training or other assigned coding instruction.
• Participates in departmental coding and educational meetings, trainings, and roundtables.
• Assists in the creation, evaluation, updating and on-going review of Desk Procedures for assigned areas.

Coder I

Manager

• Manages the day to day operations that contributes to the capture, resolution, and collection of revenue
• Responsible for managing the day to day activities of the organization as they relate to revenue cycle functions which include; billing, insurance follow up, denial management, collections, cash posting, customer service, charge entry/corrections, supervision of vendors, and accounts receivables
• Works with the Director of Hospital and Physician Business Services on revenue cycle performance to meet strategic goals and provide analytical analysis
• Develops strategic plans and programs for the revenue cycle unit and ensures that goals and objectives of the unit are properly defined and clearly established
• Monitors timeliness and effectiveness of department activities, ensuring that outstanding insurance accounts receivables, patient accounts and bad debt are on target to meet monthly/yearly Key Performance Indicators
• Delineates, defines, and streamlines its various functional activities, thereby ensure its effectiveness in maximizing the utilization of both asset and people resources
• Oversees personnel by selecting talented, competent, conscientious supervisors and other employees
• Development of supervisors and other department personnel
• Ensures that prospective employee standards are aligned with Denver Health's core values
• Coordinates communication between patient access, medical records, UM, coding, EHS and other departments as necessary

Revenue Cycle Manager

Research Analyst

• Conducts subject-related activities, such as screening and consenting for recruitment, conducting chart review, collecting samples, patient navigation and scheduling, performing subject interviews, facilitating focus groups and tracking outcomes.
• Maintains clear, concise, and organized records.
• Exercises confidentiality regarding patient and other sensitive information.
• Ensures eligibility while treating participants with courtesy, dignity, empathy, and respect.
• Acts as primary point of contact for study participants.
• Assists with data management activities, including collection and entry, and assessment for accuracy, integrity, and intervention fidelity.
• Assists in database management, analysis and reporting, and disseminating results.
• Performs literature reviews, which may include literature searches, organizing results and summarizing findings.
• Assists with preparation and maintenance of all regulatory documentation.
• Builds and maintains strong relationships with research subjects, teams, collaborators, and colleagues.
• Adheres to all protocol, policy, and regulatory requirements required to conduct human subjects research, including training requirements for COMIRB and CITI.
• Remains aware of ways to improve team processes and brings them to leadership’s attention, aligning with DHHA’s Lean management principles.

Research Associate

• Review medical record documentation to abstract and assign diagnoses, procedures, and modifiers for statistical classification and reimbursement purposes.
• Perform various coding assignments under the direction of Coding Management.
• Provide feedback regarding documentation and coding issues.
• Utilize software applications and coding references to perform coding related tasks.
• Assist with training.

Coder II

Medical writer

• Under general supervision performs concurrent and retrospective reviews as requested by the Clinical Documentation Integrity Manager or Director
• Responsible for selected assignments based on internal or external department requests
• Responsible for educating providers regarding documentation specificity, accuracy, compliance and are permitted to query physicians as deemed necessary
• Collaborates with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services and other departments to promote the common goal of obtaining accurate documentation in the patient's record
• Must participate in continuous education on ICD-10, clinical medicine, Center of Medicare and Medicaid (CMS) and other billing carriers, as well as coding guidelines and policies
• Concurrent and/or retrospective review of designated inpatient, outpatient, and ambulatory patient records to assess for accuracy, specificity, and compliance of provider documentation
• Tracking audits performed and audit results obtained in order to provide meaningful data to key stakeholders
• Educating providers regarding documentation accuracy, specificity, and compliance with rules and regulations
• Providing pertinent feedback to providers on audit results as necessary
• Working collaboratively with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services, and other departments to promote the common goal of obtaining accurate documentation in the patient record

RN Specialist, Clinical Documentation

Data Analyst

• Under minimal supervision, participates in the systems development life cycle for new development, enhancements and maintenance projects in multiple Data Warehouses
• Works closely with business leaders, end users and other technical resources to design and implement data and analytic solutions to enhance the business decision making process.
• Designs, develops and deploy ETL and data visualization software needed to prepare and deliver information in support a variety of business needs.
• Develop and support end to end Data Warehouse, Business Intelligence and Advanced Analytics solutions for analytics and management teams (25%)
• Responsible for designing, building, and supporting the components of data warehouse, such as ETL processes, databases, analytic marts and analytics environments, and other critical data pipelines (20%)
• Collaborates with the business analyst, user community, and other technical resources to thoroughly document requirements and detailed technical designs for software solutions based on functional requirements from the different business users (15%)
• Studies and understands the company’s business processes and applications, including their effect on data and analytics, and applies the knowledge gained in designing solutions to meet analytics needs (10%)
• Designs relational, dimensional and analytical models in accordance with best practices (10%)
• Perform code reviews, data validation, and system testing for data warehouse changes while establishing system documentation and ensuring it is continually sustained (10%)
• Interact closely with members of both IT and the business (10%)