Presbyterian Healthcare Services

General

• Build coding and documentation quality assurance (CDQA) strategies
• Compliance with enterprise-wide coding policies and procedures
• Perform on-site internal audits or reviews
• Develop and present educational programs
• Provide support via auditing and training for coding-related issues
• Coordinate review and tracking of appealed claims
• Research and interpret all regulatory agency regulations
• Maintain accurate documentation in electronic or hard copy form
• Respond to inquiries and requests regarding coding and auditing issues

Profee Multispecialty Coder

• Code inpatient and/or outpatient hospital records
• Ensure adherence to Hospital and Departmental Policies and Procedures
• Review patients' entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG
• Resolve any and all pre-bill edits, denials, etc. for assigned accounts
• Communicate issues to the EW Clinical Coding Manager as appropriate
• Maintain at least a 95% accuracy rate

OP Facility Coder – PRN

Medical Assistant

• Prepare patients for visits, collect clinical information, and assist providers with exams and procedures.
• Perform Medical Assistant duties within scope of practice, including administering medications, collecting specimens, and providing patient education.
• Support clinic operations by maintaining exam rooms, managing supplies, and following infection prevention standards.
• Assist with scheduling, referrals, prior authorizations, patient communications, and electronic medical record documentation.
• Collaborate with providers and the care team to deliver high-quality, patient-centered care while supporting quality and service initiatives.

Medical Assistant II

Analyst

• routinely performs in-depth analysis of workflows, data collection, and other technical issues associated with the use of Epic software
• is responsible for design, build, testing, and maintain those solutions
• Provide tier-2 support of application incidents reported through the help desk; including 24/7 on call coverage as required
• Perform analysis to resolve application incidents, maintenance items, enhancement requests, upgrades / updates, and projects, collaborating with colleagues and across teams
• Develop and maintain requirements / specifications and test cases for new or enhanced functionality to department applications
• Ensure the test scripts have been created, reviewed, and updated to reflect workflow solutions
• Modify Epic records, tables, and master files to support the application design, additions, and changes
• Implement changes using documented procedures that are compliant with departments policies and procedures
• Actively participate and contribute in team and cross-team meetings and maintain appropriate meeting records
• Have expert understanding of your supported application, integration and general understanding of most all other Epic applications
• Work independently 100% of the time
• Anticipate add on work and accomplish both within schedule.

EPIC Configuration Analyst – Optime, Anesthesia

Accounting Manager

• Performs denial follow-up activities for assigned payors utilizing work queues
• Submits corrected claims, reconsiderations and/or appeals to overturn denials
• Responsible for providing any information requested by insurance companies to process claims
• Must follow process/procedures to ensure timely follow up on outstanding denials
• Document accounts in accordance with established PHS policies/procedures

Patient Accounting Denials Specialist

Auditor

• Support the Coding and documentation quality assurance (CDQA) team
• Implementation of and compliance with enterprise-wide and department coding policies and procedures for PHS
• Compliance to all external regulatory agency coding rules and regulations
• Perform and/or manage on-site internal audits or reviews to assess compliance/quality monitoring
• Serve as a resource on documentation, coding, billing, and coding compliance questions
• Develop and present educational programs and information dissemination
• Audit and training support for coding, audit, and physician personnel identified as low performers
• Perform medical record and billing reviews of denied and appealed claims
• Coordinate review and tracking of appealed claims and communication with affected payers
• Research and interpret all regulatory agency regulations

Pro Fee Auditor/Educator

• Directly supports the responsibilities of the Coding and documentation quality assurance (CDQA) team
• Ensures compliance to enterprise-wide and department coding policies and procedures
• Performs on-site internal audits or reviews to assess compliance and quality monitoring
• Works on special coding compliance related projects and develops educational programs
• Researches and interprets all regulatory agency regulations
• Coordinates review and tracking of appealed claims
• Communicates with affected payers regarding appeals and audits

IP Facility Coder, CCS

• Perform in-depth analysis of workflows, data collection, and technical issues associated with Epic software
• Provide tier-2 support of application incidents reported through the help desk
• Perform analysis to resolve application incidents, maintenance items, enhancement requests, upgrades/updates, and projects
• Ensure the test scripts have been created, reviewed, and updated
• Modify Epic records, tables, and master files to support application design
• Actively participate and contribute in team meetings and maintain appropriate meeting records
• Create new workflows with collaboration of SME
• Support the training team by keeping trainers updated on new system functionality

Senior EPIC Configuration Analyst, Healthy Planet, Compass Rose

Procurement

• Responsible for the leadership and direction of PHS purchased services and non-clinical supplies
• Supplier selection and rationalization
• Contract negotiations
• Contracting and contract management
• Supplier certification and performance management
• Procurement requisitioning
• Supplies and services formularies
• Purchasing
• Enforcement of PHS Purchasing, Contracting, and Authorization Policies
• Optimizing labor and technology resources to provide customer-focused value analysis and procurement services
• Develop and manage strategic plan with goals and objectives
• Stay abreast of industry best practices
• Provide leadership and direction to staff
• Organize staff and resources to execute initiatives effectively
• Manage staff scheduling and assignments
• Oversee management of Opportunity Tracking Report (OTR)
• Lead efforts to integrate Value Analysis program
• Manage Supplier credentialing program
• Collaborate with Accounts Payable leadership
• Lead research and drill-down for supplies and services expenses
• Ensure compliance with all healthcare regulations and standards
• Support emergency/disaster preparedness

Director – Contracting and Purchasing

Patient Access

• Completes registration for scheduled and unscheduled visits
• Updates demographics
• Verifies insurance
• Collects point-of-service payments
• Ensures clean, accurate accounts in the ADT system
• Confirms all information meets billing and compliance requirements
• Maintains basic knowledge of Medicare and other regulatory guidelines

Patient Access Advocate – Emergency Department

• The Clinical Program & Population Health Strategist – Government Programs is responsible for advancing population health strategy for ACA, Medicaid, and Dual Eligible Special Needs Plan (D-SNP) populations.
• This role aligns with Presbyterian’s integrated delivery system (IDS) model and Health Value strategy, partnering across the health plan, medical group, and care delivery system.
• The Strategist translates enterprise population health priorities into product-specific strategies, clinical program designs, and a prioritized Clinical Initiative Portfolio.
• This role influences execution through cross-functional partnerships but does not directly manage program operations or vendor performance.
• Some key responsibilities include: Government Programs Population Health Strategy Develop population health strategies for ACA, Medicaid, and D-SNP populations aligned with enterprise priorities.
• Identify high-impact opportunities to improve outcomes for complex and vulnerable populations.
• Ensure alignment with regulatory requirements and product-specific goals.
• Clinical Initiative Portfolio Strategy & Prioritization Support development and refinement of the Clinical Initiative Portfolio.
• Partner with product owners and leadership to prioritize initiatives based on impact and ROI.
• Define success metrics aligned with HEDIS, Stars, risk adjustment, and utilization goals.
• Clinical Program Design & Strategic Guidance Design evidence-based clinical programs and interventions.
• Define target populations, program goals, and success measures.
• Partner with program and operational leaders to support implementation and scaling.
• Inform build vs. buy decisions for clinical capabilities.
• Provider Strategy & Performance Enablement Translate clinical strategies into provider-facing approaches.
• Support development of provider tools, workflows, and reporting.
• Provide input into value-based care models and provider performance strategies.
• Product & Cross-Functional Alignment Serve as liaison to Government Programs teams.
• Ensure alignment between benefit design, clinical programs, and population health outcomes.
• Collaborate with analytics, network, and operations teams.
• Analytics & Insights Partner with analytics teams to define measurement frameworks.
• Use data to identify trends, gaps, and opportunities. Translate insights into actionable recommendations.
• Regulatory & Compliance Strategy Ensure strategies align with CMS and Medicaid requirements.
• Support audits, reporting, and program integrity efforts.
• Health Equity & Community Integration Embed health equity into all strategies and program designs.
• Identify disparities and recommend targeted interventions.
• Partner with community organizations and internal teams.
• Medicare Stars and HEDIS performance.
• Medicaid quality measures.
• Gap closure and preventive care utilization.
• Total cost of care and utilization trends.
• Clinical Initiative Portfolio performance and ROI.
• Health equity outcome measures.

Clinical Program and Population Health Strategist – Government Programs

• Build your Career. Make a Difference.
• advance population health strategy for Commercial populations.
• align with Presbyterian’s integrated delivery system (IDS) model and Health Value strategy.
• partner across the health plan, medical group, and care delivery system.
• translate enterprise population health priorities into product-specific strategies, clinical program designs, and a prioritized Clinical Initiative Portfolio.
• influence execution through cross-functional partnerships but does not directly manage program operations or vendor performance.
• develop population health strategies for Commercial populations aligned with enterprise priorities.
• identify high-impact opportunities to improve outcomes across preventive care, chronic disease, and rising-risk populations.
• ensure alignment with product-specific goals, market competitiveness, contractual requirements, and employer expectations.
• support the development and refinement of the Clinical Initiative Portfolio.
• partner with product owners and leadership to prioritize initiatives based on impact and ROI.
• define success metrics aligned with HEDIS, affordability, and utilization goals.
• design evidence-based clinical programs and interventions.
• define target populations, program goals, and success measures.
• partner with program and operational leaders to support implementation and scaling.
• inform digital, virtual, and in-person care model integration.
• translate clinical strategies into provider-facing approaches.
• enable development of provider tools, workflows, and reporting.
• provide input into value-based care models and provider performance strategies.
• serve as liaison to Commercial product teams.
• ensure alignment between benefit design, clinical programs, and population health outcomes.
• collaborate with analytics, network, sales, and operational teams.
• partner with analytics teams to define measurement frameworks.
• use data to identify trends, gaps, and opportunities.
• translate insights into actionable recommendations.
• embed health equity into all strategies and program designs.
• identify disparities and recommend targeted interventions.

Clinical Program and Population Health Strategist – Commercial

• Conduct in-depth analysis of workflows, data collection, and technical issues associated with Epic software.
• Provide tier-2 support of application incidents reported through the help desk.
• Perform analysis to resolve application incidents, maintenance items, and projects.
• Develop and maintain requirements/specifications and test cases for applications.
• Modify Epic records, tables, and master files to support application design changes.

Senior EPIC Configuration Analyst – Grand Central, Prelude

Call Center Representative

• Providing customer service for members and providers in PHP benefit plans
• Responding to telephone, written, Pres Online, E-Business, chat and in person inquiries
• Retaining plan details and basic medical terminology
• Collaborating with other employees

Vice President

• The Vice President, Health Plan Analytics is the senior leader accountable for advancing analytics and insights across Presbyterian Health Plan.
• Reporting to the Chief Analytics & Data Officer, this role ensures Health Plan strategy and operations are supported by accurate, timely, and decision-ready analytics that improve affordability, quality, growth, and member experience.
• This leader is responsible for regulatory reporting, quality performance analytics, medical cost management, revenue optimization, provider network analytics, and member operations reporting.
• The VP will modernize and integrate fragmented data environments into a connected and governed platform that supports measurable business value, operational reliability, and value-based care performance.
• Drive insight generation that informs strategic decisions, performance improvement initiatives, and investment priorities.