Prisma Health

Communications

• Proactively supports organization-wide internal communications initiatives for one or more internal stakeholders
• Collaborates with leadership of assigned area to conceptualize internal communications plans to meet that area’s objectives
• Helps ensure all campaigns maintain a strong connection with the Prisma Health purpose
• Supports, strengthens and enhances the organization’s internal culture and engagement across all internal audiences
• Develops and oversees the implementation of internal communications plans to meet internal stakeholder’s objectives
• Creates and edits a variety of communication material to engage, persuade and connect with team members of diverse backgrounds at all organizational levels
• Serves as the primary point of contact for coordinating and implementing content in Prisma Health's internal communications channels
• Measures communications campaigns based on set metrics, identifies opportunities for improvement and implements follow-up actions
• Works to ensure that internal communications complements media relations, social media and marketing
• Strengthens and supports the Prisma Health organizational voice, including lexicon, tone and message, in adherence with AP Style and Prisma Health's own style guidelines
• Supports Media Relations team with media relations functions when needed

Internal Communications Specialist

Customer Support

• Performs tasks of moderate to difficult complexity relating to both hospital and physician accounts
• Handles a large volume of inbound calls assisting patients with requests for information, complaints, and resolving issues.
• Responsible for making outbound calls related to self-pay follow-up on accounts
• Resolves billing concerns, addresses inquiries related to insurance concerns/matters
• Communicates clearly and professionally in both oral and written communication

Single Billing Office Customer Service Specialist

Financial Planning and Analysis

• Performs in-depth demographic and financial assessments (generally at the bedside) and analyzes the results to determine an appropriate payor source.
• Responsible for the collection of deductibles, co-pays, and co-insurances as well as payment towards accounts classified as self-pay.
• Partners with Social Work and Outcomes Management to ensure the most appropriate continuum of care for the patient.
• Ensures elimination of all possible payor sources prior to consideration of hospital sponsorship.
• Communicates patient's estimated financial responsibility and requests payment prior to or at the time of service; appropriately explaining insurance terms to the patient.

Patient Financial Specialist, FT, Day

• 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.
• Monitor denial work queues and reports in accordance with assignments from direct supervisor and communicate all denial trends, denial increases, etc. to direct supervisor/PFS management in order to positively affect the volume of denials.
• Participate in departmental huddles and team meetings involving discussion of A/R processes and denial trends.
• Maintain required levels of productivity and quality while managing tasks in work queues to ensure timeliness of follow-up and appeals.
• Organize denial/rejection related tasks to identify patterns and/or work most efficiently (e.g., by current procedural terminology, diagnosis, payer, etc.)
• Identify and monitor negative patterns in denials/rejections. Escalate accordingly to PFS management and the impacted department(s) to avoid negative impact on reimbursement, unsuccessful appeals, and/or increased write-offs.
• Use identified and known resources to accomplish follow-up on tasks. Identify other means and resources to complete tasks, as applicable and appropriate.
• Participate in A/R clean-up projects or other projects identified by direct supervisor or PFS management as needed.
• Comply with all government regulatory mandated requirements for billing and collections.
• Work with other departments to resolve A/R and payer issues. Communicate 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.
• Enter and document appropriate accounts for adjustments utilizing the appropriate adjustment codes. Identify and research all payer issues to the Payer SharePoint in a timely manner and continue to follow-up on said SharePoint information on a weekly basis.
• Perform other duties as assigned.

Patient Financial Services Denials & Appeals Specialist

Accounts Payable

• Responsible for full cycle Accounts Payable processing of invoices, payment requests, and/or employee reimbursement requests.
• Timely processing of all invoices as assigned and verification of accuracy and authorization of invoices prior to release for payment.
• Process a minimum number of invoices daily while maintaining the overall productivity requirement.
• Troubleshoots coding and matching discrepancies.
• Ensures invoices are processed with applicable state and local sales and use taxes.
• Processes assigned invoices routed back to AP for resolution within aging deadlines while maintaining productivity requirements.
• Maintains an excellent working relationship with other departments.
• Review and approve employee reimbursement requests.

Accounts Payable Specialist

Manager

• Provides leadership for the implementation, development and support of billing applications
• Leads the day-to-day operations of the billing systems teams
• Ensures revenue cycle ITS initiatives support organizational goals and compliance standards
• Participates in and supports ITS governance committees focused on revenue cycle systems
• Collaborates with operational leaders to identify and analyze areas for improvement
• Key decision-maker for complex issues involving revenue cycle systems and workflows
• Partners with ITS and operational departments to define system requirements
• Develops and executes plans for financial systems strategy in coordination with leadership
• Prepares and manages the annual operating budget for revenue cycle systems
• Builds and maintains vendor relationships to optimize pricing, service quality, and system performance
• Ensures compliance with industry standards, data security, and privacy regulations
• Performs other duties as assigned

Manager, ITS, Revenue Cycle Systems

• Supports assigned service line(s) and/or assigned hospital.
• Interacts with all levels of management to provide analysis and recommendations that support the organization’s financial goals and strategic plan.
• Prepares monthly Internal Financial Review.
• Prepares monthly financials, including current period performance, in-depth financial trend, variance analysis, and P&L analysis for Administration.
• Develops the annual operating budget including volumes, revenue, FTEs, salary, supply, and other expenses in accordance with system profitability targets.
• Works closely with Administrator/Director and departmental leadership to provide financial support in identifying issues pertinent to department financial operations.
• Analyzes reimbursement trends to determine the impact to net collections and causes for variance.

Financial Analyst, Planning & Analysis

Support Engineer

• Provides advanced technical support for IT systems and ensures the smooth operation of technology infrastructure.
• Installs and configures ITS hardware solutions and software applications for the enterprise utilizing approved deployment tools and methods
• Troubleshoots and resolves complex challenges related to ITS hardware and software.
• Acts as Clinical and Business Systems Analyst for applications issue resolution as required including during emergency situations
• Performs hardware and software updates to ITS solutions including mobile devices.
• Creates and maintains standards documentation related to hardware and software solutions including mobile devices.
• Provides training and support to end-users on the use of IT systems and software
• Conducts regular audits of IT equipment and ensure compliance with company policies
• Utilizes active directory to support the enterprise needs
• Performs other duties as assigned.

Technical Support Engineer

Auditor

• Responsible for leading coding teams, coder training, work que management, performing prebill and second-level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation.
• Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership.
• Employ critical thinking skills to alert coding leadership to any trends identified in their reviews and to make suggestions for continual process improvement.
• Reviews and responds to inpatient denials as needed.
• Performs Inpatient coding by assigning ICD-CM and ICD-PCS codes as well as DRG assignment.
• Conducts review and audit of discharged inpatient records (prebill and retrospective reviews) to validate the coding/DRG assignment according to official coding guidelines as supported by the clinical documentation in the record.
• Monitors work queues daily to identify, prioritize and assign accounts that need to be coded based on department-specific guidelines and within designated timelines in coordination with leadership.
• Mentors and trains coders on application of correct ICD-CD and ICD PCS guidelines.
• Coordinates and identifies provider documentation queries for the Clinical Documentation Integrity team to send to clinical providers.
• Identifies coding and documentation opportunities following established guidelines when existing documentation is unclear or ambiguous following American Health Information (AHIMA) guidelines and established policy.
• Maintains working knowledge of Centers for Medicare & Medicaid Services (CMS) regulations and applicable carrier local medical review policies.
• Consults, provides professional expertise to and collaborates with clinical documentation specialists on coding and documentation practices and standards.
• Collaborates with Coding and CDI to develop and maintain coding curriculum and training materials.
• Assists with and develops educational programs for coding staff, clinical documentation staff and medical staff to including yearly coding/DRG updates.
• Applies ICD and ICD-PCS codes including major traumas, and Neonatal Intensive Care Unit (NICU) records based on review of clinical documentation.
• Verifies assignment of DRGs, MCC/CCs, Hospital Acquired Conditions (HACs) and Patient Safety Indicators (PSIs) that most appropriately reflect documentation of the occurrence of events, severity of illness, and resources utilized during the inpatient encounter and in compliance with department policies and procedures.
• Codes inpatient records periodically based on review of clinical documentation.
• Identifies and assists management with the resolution of coding issues, process improvement and system testing for HIM applications.
• Interacts with other departments to resolve coding issues and assists with coding and clinical validation denials.
• Participates in on site, remote and/or external training workshops and training.
• Attends and participates in CDI-Coding Task Force and other collaborative training and education with CDI, PFS, Specialty areas and Quality.
• Performs other duties as assigned.

Senior Health Information Management Inpatient Coding Auditor

Supply Chain

• Responsible for Supply Chain Inventory Control for a designated area of the health system
• Provides day-to-day supervision of department staff, including training and development
• Works with Supply Chain staff to implement a system-wide inventory strategy
• Coordinates physical inventory and cycle counts as needed
• Leads the conversion process, ensuring a smooth implementation process
• Utilizes standardized system-wide dashboard analytics to track inventory levels
• Conducts regular meetings and rounds with clinical representatives

Supervisor – Inventory Control

Analyst

• Configures programs, screens, pathways, reports, and/or job instructions to meet detailed user specifications
• Supports I/S Epic Analysts in providing technical assistance to customer departments and maintains databases for one or more applications supported by the team
• Works with assigned departments to prioritize development initiatives and activities
• Coordinates and resolves system problems related to technology used by assigned systems
• Supports internal customers in functional areas including nursing, ancillary departments, physician practice, patient accounting, medical records, finance, human resources, purchasing, sales, and contracts
• Assists in managing system upgrades and other small projects

Epic Analyst Associate

Software Engineer

• Leads and provides technical expertise in the design, development, testing, documentation, maintenance of Epic reporting and analytics solutions.
• Utilizes reporting tools including but not limited to Clarity and Caboodle reports, extract framework, metrics, benchmarking, Radar, Reporting Workbench, and Slicer Dicer.
• Responsible for the design/development/creation of custom code and stored procedures to package for processing using SSIS.
• May also assist in the generation of XML files in QRDA format for electronic submission of quality measures data.
• Requires a strong technical background including multiple technical disciplines and expertise in healthcare analytics development.
• Requires mentorship/guidance to less experienced team members and serves as a subject matter expert for all Epic/Cogito applications.
• Utilizes knowledge in SQL, Reporting Workbench, Slicer Dicer, and other reporting technologies to design and troubleshoot both custom and foundation reports that fulfill business requirements.
• Performs testing of report/dashboard configurations and builds in appropriate non-production environments, to identify defects and create resolution plans accordingly.
• Creates and maintains documentation for change management.
• Follows specifications to develop reports within the Epic framework, ensuring high quality reporting is delivered to the end user's needs.
• Collects information on potential report enhancements and functionality needs, preparing detailed specifications as required.
• Works cohesively with stakeholders to provide system support including analysis, build, and testing of requested changes, and analysis of new Cogito features.
• Applies comprehensive knowledge of the Epic data model (Chronicles, Clarity, and Caboodle) to identify and utilize data structures that enhance the reporting environment.
• Applies analytical and problem-solving skills to identify, communicate, and resolve issues, maximizing the Epic's potential.
• Participates in troubleshooting of software and workflow issue identification to define mitigation plans for resolution with minimal guidance.
• Manages report requests and changes, analyze new functionalities in Epic releases to determine utility, and maintain detailed documentation for all reports.
• Maintain the Analytics Catalog and associated metadata records.
• Maintains ongoing communication with Epic representatives and the end user community to ensure the system meets organizational needs.
• Provides expert support during implementation phases, upgrades, and application rollouts.
• Fosters strong collaborative relationships with various Epic application teams across the organization to share insights, gather requirements, and identify opportunities for improved reporting solutions.
• Provides mentorship and support to the team through knowledge sharing and advanced knowledge of the Epic environment.
• Performs other duties as assigned.

Senior Enterprise Intelligence Developer

• Answers incoming calls from patients who want to place orders, respond to inquiries, manage complaints, troubleshoot significant customer service problems, and provide general information.
• Member of the primary contact team for consumers interested in the products we offer and will be responsible for assisting them in completing purchases online and over the phone.
• Inform customers of the product terms and features and project a professional company image through voice and online interactions.
• Receives customer input from phone, email, or web submission and create support tickets.
• Troubleshoots end user issues and determine if the issue can be resolved at Tier 1 or if it needs to be escalated to Tier 2 using established criteria and process.
• Resolves tier1 issues using troubleshooting resolution matrix.
• Gathers information from customers to ensure sufficient data is gained to start case resolutions.
• Conducts database lookup of consumer/patient records within electronic medical record software.
• Enters updated information within electronic medical records as required.
• Re-directs or engages other departments or specialty groups to resolve consumer/patient requests.
• Maintains compliance with attendance and schedule adherence requirements.
• Maintain interaction quality standards.
• Maintain performance standards.
• Proactively identify and share customer insights in order to recommend process improvements.
• Remain current with product/applications/process changes.
• Follows-up and follows-through on open tickets, requests, promises, and questions that have not been answered to provide callers with a resolution.
• Logs interaction outcome in contact management system.
• Performs other duties as assigned.

Support Analyst, Customer Wayfinding, My Chart

• Responsible for monitoring and/or resolution of high dollar, high profile, escalated accounts.
• Ensures timely and accurate posting, adjustments, correspondence, and/or denials.
• Ensures complete, accurate, and compliant processes resulting in optimal collection and customer service performance for the organization.
• Supports various special projects ensuring billing, AR, and denial prevention are optimal.

Patient Financial Services Analyst

• To serve as the lead developer in support of corporate business systems, primarily Workday systems.
• Provide technical support, lead the analysis and business case development for interfaces, enhancements and business process changes.
• Drive the testing and acceptance of changes.
• Provide technical expertise and leadership in the design, testing and debugging of significant enhancements to new/existing software applications.
• Perform complex system configuration, development and report development activities.
• Collaborate with internal/external resources to accomplish required activities.
• Assess the feasibility of complex system enhancements or process changes and their impact on Workday and ancillary systems.
• Test and deploy Workday system updates including executing the pilot/implementation/deployment of new requirements or enhancements to the Workday application and integration support.
• Design, develop, test and deploy integrations using all Workday tools including Studio, Core Connectors, and EIBs.
• Lead Workday release implementations, identifying impact enhancement opportunities associated with new release features/functionality.
• Investigate and resolve complex system-related issues and support the business with escalating issues to the appropriate vendor or internal system owner.
• Design, develop, test, deploy and maintain, complex Workday Dashboards, apps, advanced and shared reports using Workday delivered tools.
• Serve as a Workday product technical specialist, building relationships with key business users as well as third-party vendors to ensure that the services and solutions provided meet current and future business needs.
• Focus on quality and adhere to established escalation, change control and communication practices of the ITS department.
• Coordinate the preparation, installation, deployment and production support of applications and Epic modules, including workflow analysis and flow charting, design specifications, programming and/or building, testing, training and implementation.
• Manage the purchase of appropriate hardware/software for new projects - under the direction of the respective IS Project Manager.
• Develop a timeline for implementation and ensure that all steps are taken to close all outstanding issues regarding the new implementation.

Senior Workday Developer

Implementation Specialist

• The Implementation Manager and Business Development Representative plays a key role within the sales and account management department of Promise Health Plan.
• The Implementation Manager and Business Development Representative supports sales and account management staff by leading the implementation process for new business and existing Promise Health Plan customers.
• The Implementation Manager and Business Development Representative will work with brokers to complete client onboarding paperwork and will provide that information to Promise Health Plan's vendor partners.
• The Implementation Manager and Business Development Representative will need to be highly organized and detail oriented to ensure that new business is onboarded accurately.
• The Implementation Manager and Business Development Representative will log all sold customer details in client database.
• In addition to leading the onboarding of new Promise Health Plan customers, the Implementation Manager and Business Development Representative will support the new business sales team with business development activities.

Implementation Manager, Business Development Representative

Account Executive

• Experienced business and sales professional responsible for identifying, researching, and establishing long-term employer relationships
• Selling Employer Health Services and products through targeting employers located within an applicable region
• Communicates directly to prospects and clients, understands client needs, and recommends Employer Health and other Prisma Health services
• Leads the development of strong lasting relationships with business and community partners
• Supports business development including customer identification, cold calling, appointment setting, and documenting all activity in CRM (Salesforce)
• Responsible for establishing and maintaining relationships with client company representatives
• Partners with other Employer Health Services leaders and represents sales in the overall strategy, client identification and product implementation.

Health Services Sales Consultant

• Interacts with departmental revenue owners to monitor charge capture, revenue reconciliation and revenue trending across Prisma Health
• Completes focused charge review audits for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes
• Works assigned Epic charge review and billing work queues to meet our compliant standardized min daytime frame, ensuring appropriate medical documentation exists to support charge capture compliance
• Validates assigned principal diagnosis, all secondary diagnoses, principal procedures, and all secondary procedures and CPT/HCPCs codes
• Advises departmental revenue owners and their staff on proper usage of charge codes, identifies opportunities for capturing additional revenue in accordance with payer guidelines and develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections
• Reviews and applies appropriate billing guidelines, state and federal regulations, and third-party billing rules/coverage
• Completes internal charge review audits for assigned clinical departments to ensure that charges are generated in accordance with established policies and timeframes
• Assist with monthly, quarterly, and yearly Charge capture revenue reconciliation auditing, reporting and education
• Partners with vendors for optimization projects to complete data review, auditing, and testing
• Performs other duties as assigned

Charge Capture Analyst

• Identify trauma patients meeting registry inclusion criteria per SC Trauma Registry Data Dictionary, NTDB and ACS standards
• Abstract clinical and outcomes data from pre-hospital EMS database and in-patient medical record (demographics, co-morbidities, diagnoses, injuries, ED data, operations, procedures, complications, outcomes, performance improvement, and financial data)
• Code procedures, diagnoses, and injuries using ICD-10, AIS injury coding, E-codes and enter data into Trauma Registry
• Maintain registry within NTDB, State Trauma Registry Data Dictionary, and PHR Trauma Program standards
• Perform data analysis and data validation for monitoring data quality, errors, and omissions
• Prepare reports for performance improvement, research, administrative and medical staff meetings, injury prevention, and Trauma Center designation/verification
• Prepare, process and submit Trauma Registry records to State Trauma Registry quarterly and annually to NTDB
• Participate in performance improvement monitoring and report trends to PI Coordinator and TPM
• Ensure compliance with Palmetto Health HIPPA and IRB research policies
• Attend and participate in Multi-disciplinary Trauma Patient Care Conference, Committees, and Trauma Association of South Carolina
• Work with Trauma Registry software vendor and PHR IT on data submissions, upgrades, imports, and enhancements
• Respond to information requests and write reports to support coding, billing, trauma research, injury prevention, and other Trauma Program activities

Trauma Registry Analyst

• Answers incoming calls from patients who want to place orders, respond to inquiries, manage complaints, troubleshoot significant customer service problems, and provide general information.
• Member of the primary contact team for consumers interested in the products we offer and will be responsible for assisting them in completing purchases online and over the phone.
• Inform customers of the product terms and features and project a professional company image through voice and online interactions.
• Receives customer input from phone, email, or web submission and create support tickets.
• Troubleshoots end user issues and determine if the issue can be resolved at Tier 1 or if it needs to be escalated to Tier 2 using established criteria and process.
• Resolves tier1 issues using troubleshooting resolution matrix.
• Gathes information from customers to ensure sufficient data is gained to start case resolutions.
• Directs inbound service interactions to appropriate technical and sales resources.
• Conducts database lookup of consumer/patient records within electronic medical record software.
• Enters updated information within electronic medical records as required.
• Re-directs or engages other departments or specialty groups to resolve consumer/patient requests.
• Maintains compliance with attendance and schedule adherence requirements.
• Maintain interaction quality standards.
• Maintain performance standards.
• Proactively identify and share customer insights in order to recommend process improvements.
• Remain current with product/applications/process changes
• Follows-up and follows-through on open tickets, requests, promises, and questions that have not been answered to provide callers with a resolution.
• Logs interaction outcome in contact management system.
• Performs other duties as assigned.