Franciscan Missionaries of Our Lady Health System

General

• Assists in the development and maintenance of financial information related to volume, financial performance, and profitability for each managed care contract.
• Prepares preliminary interpretations of analysis for project teams, departments and/or management.
• Assists in developing reimbursement strategies and policies and procedures related to contract negotiations.
• Obtains and maintains current information and knowledge of the managed care environment, including but not limited to local, state and national developments; and develops and maintains relationships with appropriate agencies.
• Assists in contract negotiations.
• Ensures that changes in managed care processes are communicated to and followed by FMOLHS and affiliated entity employees in a manner that ensures high quality patient care.
• Strives to promote the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops.
• Works collaboratively with internal departments (i.e., Financial Operations, Revenue Management, Business Office, etc.) to ensure reimbursement is optimized and to resolve identified issues.
• Assists in the resolution of identified operational issues with contracted payers. This includes resolution of reimbursement, operational and clinical issues.
• Works with affiliated entities in the development and maintenance of managed care contracts and strategies.

Payor Relations Coordinator

Patient Access Representative

• Responsible for accurately registering patients in EMR including validating patient information, verification of insurance coverage, collection of required payments and ensuring the patient's experience is best in class.
• Works under close supervision.
• Monitors and manages the flow of patients through the clinic.

Patient Access Representative – Physician Enterprise Quality

Revenue Cycle Specialist

• Revenue and Reimbursement Management
• Insures the appropriate bundling or unbundling of charges so that all charges are submitted result in maximum reimbursement while following applicable billing, coding and reimbursement regulations.
• Interprets Medicare transmittals to determine whether new codes, coding changes, or directives that alter billing and compliance are required and to communicate these changes to all relevant departments.
• Proactively identifies new charge opportunities and makes monthly recommendations to prevent future billing problems.
• Manages the process of CDM maintenance including the training and supervision of staff in order to process CDM request in a timely response to decrease bill rejections and payment delays due to chargemaster driven coding and charging issues.
• Effectively utilizes all internal automation and software applications. Prepares reports as required by management regarding process improvement recommendations and systematic claim processing issues.
• Answers questions regarding hospital and departmental operations, policies and procedures.
• Assist Payer Relations with contract analysis to receive maximum reimbursement.
• Develop or modify revenue and reimbursement reports to prevent a disruption in the revenue stream.
• Quality
• Safeguards the hospital against exposure to denials, penalties and fines by ensuring healthcare services are billed accurately and properly at all times.
• Coordinates and performs the analysis of the yearly charge change recommendations and pricing schedule changes recommended by the contracted Revenue Consultants.
• Collaboration and Partnership
• Assists the billing personnel in resolving third party payor billing problems and works to streamline the revenue cycle in coordination with Department Managers, Business Office, HIM and Managed Care to increase charge capture, receive accurate payments from payers and minimize claim denials.
• Assists departments in coordinating, compiling and interpreting information regarding health care services and operating costs in an effort to create efficient charging practices and the capture of appropriate revenue.
• Performs in-house education regarding revenue cycle/indicators for Department Managers.
• Other Duties As Assigned
• Performs other duties as assigned or requested.

Chargemaster Revenue Cycle Specialist

• Accurately and efficiently registers patients in Epic.
• Monitors and manages the flow of patients through the clinic utilizing initiative to ensure the patient experience is best in class.
• Monitors patient schedules and reviews accounts to determine the patient's financial responsibility on account balance and arranges payment plans to collect.
• Assists patients with access to government and community resources to enhance their access to health care services.
• Works closely with physicians, nurse practitioners and nursing staff to ensure that referrals to other providers/services/facilities are completed in accordance with payor requirements in a timely manner.
• Facilitates the patient's access to information including but not limited to MyChart access.
• Accurately updates patient records as needed.
• Accurately enters patient charges as necessary.

Patient Access Representative – Patient Scheduling

• Evaluates potential rehab candidates referred to OLOL Rehabilitation Center and functions as a liaison between OLOL and referral sources. Pre-admission assessments are conducted under the criteria and guidelines of CMSs IRF-PPS to ensure appropriateness of admission and to determine medical necessity.
• Works with healthcare team to develop rehab treatment/discharge plan.
• Conducts weekly Admissions Committee meetings with Medical Director to determine appropriate admissions and communicates information to nursing team.
• Maintains archives of denied patient assessments for the required period.
• Develops, builds, and maintains professional relationships with current or potential referral sources. Understands the capabilities of outside referral sources (such as home health, skilled nursing, etc) and the requirements for prior approval by payors for admission, continued stay, and discharge.
• Contributes to community and professional education. Assists with marketing efforts and customer satisfaction to ensure continuation and/or expansion of referral base. Participates in SPIRIT classes as requested to explain inpatient rehab, the referral process, rehab qualifications and expectations.
• Obtains timely pre-certification and insurance verifications from third-party payors to support effective reimbursement for admissions. Uses 3M and RUMBA programs to verify and document insurance information. Serves as liaison with HCR office for Medicaid applicants. Communicates with business office when insurance changes occur. Communicates insurance/payor information to patients and families.
• Understands IRF-PPS regulatory criteria and how to access resource information from CMS, MACs, etc. in order to maintain optimum reimbursement for the unit. Initiates and completes the IRF-PAI. Demonstrates ability to maximize financial outcomes with effective coding of the IRF-PAI.
• Collaborates with HIM and physicians to ensure appropriate capture of coding that supports medical necessity criteria. Communicates CMG information to the interdisciplinary team in order to facilitate care planning.
• Communicates approval status with referral sources, patients and families in a timely and effective manner. Interacts with team members to facilitate alternate placement in the event of denial or inability to admit to OLOL Rehabilitation Center.
• Communicates information with patients and families about the rehab physician, expectations of the inpatient program, discharge planning, family training, and team conferences. Provides tours of the unit upon request.
• Demonstrates ability to access and utilize community resources. Is knowledgeable of ADA and other federal guidelines that support individuals with disabilities. Appropriately refers patients/families to community resources for additional support.
• Other duties as assigned
• Other duties as assigned

Rehabilitation Liaison

IT Support

• Provides high-quality, consistent end user support services for all employees within FMOLHS. Troubleshoots and resolves end user issues by guiding user through corrective steps. Documents, logs, escalates, and follows up on issues with end users and sites. Coordinates with other IS areas to resolve problems if necessary.
• Assists in the development of, and complies with, all standards regarding documentation, end user instructions, computer deployment, ticket logging, and monitoring.
• Utilizes computerized support tracking system to accurately and effectively track user support statistics for adherence to SLA and to allow planning for staffing levels.
• Research new developments in hardware and software and keeps abreast of the latest developments and studies involving computer-related procedures and methods.
• Prepares, reviews and contributes to online support knowledgebase for FMOLHS applications and systems. Remains current with the latest trends in field of expertise by participating in ongoing training and development as directed by management.
• Develops and implements data driven performance improvement methodologies. Maintains accurate records for use in evaluating organizational performance. Identifies ways of improving current services and consults with management on issues and problems.
• Ensures security, integrity, and privacy of FMOLHS data in conjunction with FMOLHS policies and procedures.
• Utilizes IS project management methodology and best practices to improve individual and organizational efficiency, effectiveness, and outcomes.

Help Desk Technician

Account Manager

• The Patient Accounts Representative 2 works with patients, co-workers and external agencies to ensure the prompt payment and/or reimbursement of hospital and/or professional charges.
• The Patient Accounts Representative 2 is responsible for the monitoring of patient accounts which includes, but is not limited to: claim submissions, researching and reviewing back end denials; determining appropriate action for submission of provider claims; outbound and inbound calls from insurance carriers, providers and patients; payment posting; collections; account adjustments and appeals.

Patient Account Representative 2 – Hospital

Human Resources

• Answers and responds to incoming phone calls in adherence with protocol and service standards
• Provides assistance to managers and employees with time-sensitive requests, such as HRIS (Lawson) navigation, etc.
• Provides first-level assistance to managers and employees with HRIS self-service tools
• Assists employees and managers in all stages of the employee life cycle (onboarding, job changes, retirement, etc.)
• Initiates contact or makes referrals to the appropriate resource for situations that require specific attention or on behalf of other HR Centers of Excellence (CoE)
• Investigates, and resolves first level Human Resources and benefits issues.
• Maintains accurate and timely documentation and recordkeeping related to human resource and benefit activities in the designated database(s) and in adherence with human resource and benefit policies and applicable regulations.
• Participates in and share expertise during team meetings and training sessions.

HR Performance Center Representative 2

Medical Staff Coordinator

• Process observation requests and conduct provider orientations.
• Maintain on-call schedules, schedule provider shifts, and coordinate on-call payment processes.
• Conduct surveys and ensure compliance with regulatory standards, accrediting agencies, and Medical Staff Bylaws.
• Serve as a provider liaison with the System Verification Office for timely credentialing.
• Coordinate meetings and manage committee action items.
• Assist in troubleshooting and resolving credentialing issues when needed.
• Participate in investigations or disciplinary actions impacting medical staff members.
• Collaborate on shift schedules, job openings, new provider orientations, and staffing needs.
• Handle special projects as assigned.

Claims Specialist

• The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS.

Oncology Claims Analyst

Affiliate Manager

• Coordination of Care
• Reviews evidenced based care measures for population of patients, assists providers with organizing pre-visit patient care needs.
• Prepares for clinic interdisciplinary team meetings.
• Work within the data warehouse and disease registry to identify gaps in patient care.
• Observes, records and reports patient's condition and reaction to drugs and/or treatments.
• Performs other duties as assigned or requested.

Clinical Care Partner – Medical Assistant

Analyst

• Facilitates EPIC vision development, solution design, standards guidance, project scoping, IS strategy integration and implementation of efficient, high-quality technology and applications systems.
• Evaluates technology, systems and application capabilities, analyzes workflow/data flow, and creates efficient and logical solutions. Plans, schedules, reviews, and performs analysis, design, construction, testing, and implementation of assigned technology and application systems. Participates in solution testing and documents clear and concise system descriptions that meet project requirements and departmental quality standards.
• Collaborates with FMOLHS Information Services, leaders, team members and end users to develop efficient, cost-conscious technology and applications system specifications that maximize organizational performance.

EPIC Application Analyst 4 – PB Claims

• Facilitates Epic vision development, solution design, standards guidance, project scoping, IS strategy integration and implementation of efficient, high quality technology and applications systems.
• Evaluates technology, systems and application capabilities, analyzes workflow/data flow, and creates efficient and logical solutions. Plans, schedules, reviews, and performs analysis, design, construction, testing, and implementation of Epic and related application systems. Participates in solution testing and documents clear and concise system descriptions that meet project requirements and departmental quality standards.
• Collaborates with FMOLHS Information Services, leaders, team members and end users to develop efficient, cost-conscious technology and applications system specifications that maximize organizational performance.
• Develops and implements data driven performance improvement methodologies. Maintains accurate records for use in evaluating organizational performance. Identifies ways of improving current services and consults with management on issues and problems.
• Ensures security, integrity, and privacy of FMOLHS data in conjunction with FMOLHS policies and procedures.
• Strives to promote the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops, attendance at professional conferences, and affiliations with national and state professional organizations.

EPIC Application Analyst 2

• Provides customer service support by responding to questions and performing benefits cycle processing and data updates
• Answers questions around network tier exceptions
• Follows standard forms, communications and processes
• Recognizes when to escalate issues to SME
• Understands regulations and regulation changes

HR Performance Center Representative

Medical writer

• Improves the accuracy and completeness of clinical documentation in medical records
• Performs thorough reviews and requests clarifications from clinicians
• Facilitates modifications that accurately reflect patient severity, risk, and resource use
• Collaborates with clinicians and coders
• Ensures compliance with regulatory guidelines
• Supports accurate reporting of provider and hospital outcomes
• Actively contributes to operational improvements
• Participates in education and program-related activities