Prisma Health

General

• Communicating and providing information which meets the payor requirements for initial notification of Inpatient admissions and Observation
• Timely completion of insurance verification and authorization related activities to financially secure patient accounts
• Timely submission of appropriate documentation to meet third party payor requirements.
• Collaborates as appropriate with other departments to ensure efficient processes and facilitate problem solving
• Verifies insurance coverage/benefits utilizing online eligibility or by telephone inquiry to the employer and/or third party payor
• Interviews patients or representatives to secure information relative to financial status, demographic data and employment information when necessary

Admission Specialist

• Responsible for underwriting new and renewal medical stop loss business
• Reviewing, evaluating, selecting, and rating each risk to maximize premium revenue
• Responsible for the development, implementation, and maintenance of underwriting programs, policies, procedures, and guidelines
• Reviews Group health insurance applications and medical records to evaluate risk
• Uses underwriting software, A.I. tools and actuarial manuals to calculate rates, premiums, and factors
• Performs detailed pricing analysis and contribute to pricing strategies to optimize profitability
• Reviews stoploss offers and makes recommendations to the sales team
• Creates and updates financial models for forecasting and budgeting
• Conducts analyses to identify key metrics for modeling financial data
• Compiles data on yearly loss ratios and medical trends for program evaluation
• Communicates with stop-loss partners regarding risk levels and forecasted claims costs
• Consults with payer staff to obtain information, review insurance laws, and explain underwriting policies
• Collaborates with internal teams to understand monthly trends and ensure comprehensive risk evaluation
• Develops and maintains strong relationships with brokers, agents, and reinsurers
• Prepares detailed reports and documentation to support health plan decisions
• Maintains accurate records of underwriting decisions and related data
• Ensures compliance with legal standards and stays current on industry regulations and legislative changes
• Conducts regular audits of underwriting files to ensure quality and compliance

Underwriter, Contracting & Network Development

Customer Support

• Support the department by performing as a liaison for payer communication
• Assisting with patient's transitions of care
• Delivery of required regulatory documents
• Supports patient throughput by performing transition of care activities (e.g., referrals and placement for post-acute services)
• Providing notification letters to patient/family regarding regulatory rights
• Maintaining consistent communication with Post-Acute Providers and Care Management staff
• Manages all payer communications, including faxes and voice mails from payors for authorizations and denials
• Communicates with payors regarding discharge dates and dispositions
• Documents communications in the EMR with payors, delivery of forms, and interactions with patients and care team members, as appropriate.

Support Specialist

Software Engineer

• Serves as the lead developer in support of corporate business systems, primarily Workday systems.
• Provides technical support, lead the analysis and business case development for interfaces, enhancements and business process changes, and drive the testing and acceptance of changes.
• Perform complex system configuration, development and report development activities.
• Collaborates with internal/external resources to accomplish required activities.
• Assesses the feasibility of complex system enhancements or process changes and their impact on Workday and ancillary systems.
• Tests and deploys Workday system updates including executing the pilot/implementation/deployment of new requirements or enhancements to the Workday application and integration support.
• Designs, develops, tests and deploys integrations using all Workday tools including Studio, Core Connectors, and EIBs.
• Leads Workday release implementations, identifying impact enhancement opportunities associated with a new release features/functionality.
• Investigates and resolves complex system-related issues and support the business with escalating issues to the appropriate vendor or internal system owner.
• Designs, develops, tests, deploys and maintains, complex Workday Dashboards, apps, advanced and shared reports using Workday delivered tools.
• Serves 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.
• Focuses on quality and adheres to established escalation, change control and communication practices of the ITS department.
• Coordinates 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.
• Manages the purchase of appropriate hardware/software for new projects - under the direction of the respective IS Project Manager.
• Develops a timeline for implementation and ensures that all steps are taken to close all outstanding issues regarding the new implementation.
• Takes a lead role in maintaining customer relations and resolving customer issues related to software applications before involving the Manager.
• Interacts with users to develop plans to resolve their problems regarding the use of applications.
• Responsible for I/S communications to assigned departments concerning system status, downtime plans or other specific I/S involved events using various means such as the I/S intranet page, global emails, etc.
• Requires routine scheduled on call.
• Performs other duties as assigned.

Senior Workday Developer

Analyst

• Lead position in analyzing clinical, business and/or technical processes and problems
• Formulating and developing recommendations for new and modified systems
• Provides advanced technical expertise in identifying, evaluating and developing systems
• Gathers and works with departments to prioritize development initiatives
• Provides analysis of workflow, recommends solutions, and implements application solutions
• Mentors Associate and Mid-level I/S Analysts in their roles
• Manages system upgrades and large projects

Senior Epic Analyst

Data Analyst

• Supports the operational efficiency of the Pharmacy Department by coordinating fiscal management activities, performing data analysis, and maintaining departmental statistics and reports
• Responsible for developing, preparing, and maintaining quality data analytics that will be utilized by leadership and management
• Publish quality analytics to include weekly or monthly dashboards, productivity, ad-hoc projects, and/or KPI used by directors and managers
• Maintain system databases to reflect changes in the drug formulary or product specifications
• Define new data collection and analysis processes

Business Data Analyst, Pharmacy

Patient Access Specialist

• Receives and interviews patients to collect and verify pertinent demographic and financial data
• Verifies insurance and initiates pre-authorization process when required
• Collects required payments or makes necessary financial arrangements
• Performs all assigned duties in a courteous and professional manner
• Interviews patient or other source to secure information relative to financial status, demographic data and employment information
• Enters accurate information into computer database
• Verifies insurance coverage/benefits utilizing online eligibility or by telephone inquiry to the employer and/or third party payor
• Obtains necessary signatures and other information on appropriate forms and documents as required
• Receives payments and issues receipts, actively working toward collection goals
• Prepares and distributes appropriate reports, documents, and patient identification items as required
• Communicates to patients their estimated financial responsibility.

• Responsible for communicating and providing information which meets the payor requirements for initial notification of Inpatient admissions and Observation
• Timely completion of insurance verification and authorization activities
• Collaborates with other departments to ensure efficient processes and facilitate problem solving
• Acts as the initial point of contact to all payors for Inpatient admissions and Observation.
• Ensures appropriate statistical data is obtained for patients in assigned patient population areas
• Verifies insurance coverage/benefits utilizing online eligibility or by telephone inquiry
• Initiates pre-certification process as required
• Interviews patients or representatives to secure information relative to financial status and demographic data

Admission Specialist, FT, Days

Advocate

• Represents Prisma Health with patients, families, and visitors in responding to concerns.
• Partners with senior patient advocates, patient safety, quality and risk management to address more clinically focused and complex concerns.
• Coordinates the resolution of complaints and grievances with leaders and physicians across the continuum of care including acute, post-acute, and ambulatory care settings in compliance with CMS guidelines and other regulating bodies.
• Models exemplary patient experience and professionalism.
• Coordinates prompt, sensitive, and professional resolution to each concern, tracking and monitoring actions taken by those involved in investigating the complaint.
• Serves as a liaison between providers, team members and patients/families to facilitate two-way communication, support, and information.
• Responds to difficult situations with patients/families across the continuum of care using service recovery methodologies.
• Effectively coaches leaders and team members in service recovery methodologies.
• Is self-motivated, meets deadlines, and is highly reliable.
• Models exemplary patient experience and professionalism at all times.
• Participates in Patient Family Advisory Councils and organizational committees as assigned.

Patient Advocate, PT

• Analyzes clinical, business and/or technical processes and problems
• Formulates and develops recommendations for new and modified systems
• Provides technical expertise in identifying, evaluating and developing systems
• Gathers and works with departments to prioritize development initiatives
• Provides analysis of workflow and recommends solutions
• Translates departmental requests into business functional requirements
• Performs financial analysis/business plan/impact assessment
• Supports internal customers in various functional areas
• Manages system upgrades and small projects
• Develops a timeline for implementation and ensures that all steps are taken to close outstanding issues

Application Analyst, Identity and Access Management

Pharmacist

• Provides patient care through the provision of direct operational and / or clinical patient services
• Ensures the safe and appropriate use of medications through the provision of drug information
• Confirms the appropriateness of drug therapy as it relates to the care of specific patient populations
• Oversees pharmacy support personnel; checks and verifies the accuracy of all tasks performed
• Completes lab reviews, pharmacy consults and provides clinical services
• Provides experiential education and training for pharmacy technicians, students and new team members

Pharmacist, PT

Security Engineer

• 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.
• Maintains system hardware and/or software for one or more of the supported applications.
• Working with more advanced Analysts, provides analysis of workflow, recommends solutions, and implements application solutions to meet departmental needs.
• Coordinates and resolves system problems related to technology used by assigned systems.
• Supports internal customers in such functional areas including, but not limited to, 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, Epic Security Team

Financial Planning and Analysis

• Responsible for monitoring and/or resolution of high dollar, high profile, escalated accounts
• Ensures timely and accurate posting, adjustments, correspondence, and/or denials
• Supports various special projects ensuring billing, AR, and denial prevention are optimal
• Monitors, research and/or resolves high dollar, high profile, and problem accounts
• Identifies trends and works with other departments to resolve system issues
• Evaluates payer performance and payment trends
• Assures timely communication of all meeting outcomes to appropriate PFS team members
• Maintains professional growth and development through seminars, workshops, and in-service meetings
• Responsible and accountable for reconciliation and accuracy of vendor invoices

Patient Financial Services Analyst

• Configures programs, screens pathways, reports and/or job instructions to meet detailed user specifications
• Supports Information Systems Analysts in providing technical assistance to customer departments
• Maintains databases for one or more applications supported by the team
• Works with assigned departments to prioritize development initiatives and activities
• Maintains system hardware and/or software for one or more of the supported applications
• Provides analysis of workflow, recommends solutions, and implements application solutions to meet departmental needs
• Coordinates and resolves system problems related to technology used by assigned systems
• Supports internal customers as assigned
• Assists in managing system upgrades and other small projects

Application Analyst Associate

• Responsible for leading the analytics development from the vast array of data sources maintained by Prisma and turning them into actionable insights.
• Tasked with designing and implementing robust data models, analyzing data from diverse sources to identify metrics and KPIs that align with Prisma's operations and goals.
• Develop detailed, visually compelling dashboards, reports, and visualizations using data visualization tools like Power BI.
• Collaborate with stakeholders to understand their requirements and translate them into actionable Power BI solutions.
• Ensure the accuracy, reliability, and integrity of healthcare data by implementing data quality checks and validation processes.
• Analyze trends, patterns, and anomalies in healthcare data to identify areas for improvement and optimization.
• Provide data-driven recommendations and insights to support strategic decision-making and drive organizational performance.