Prisma Health

Administration

• Responsible for the development and coordination of pre-award documents
• Oversight and project financial administration during the award life cycle
• High level customer service to researchers and departments
• Liaison with sponsors
• Prepare proposal documents, budgets, and supporting internal forms
• Ensures complete, compliant submissions and account management
• Performs post-award administrative functions
• Remains up to date on research administration policies and sponsor guidelines
• Identifies appropriate funding opportunities and connects researchers
• Supports pre-award compliance activities

Grants Administrator

Medical Billing and Coding

• Responsible for validating coding and facilitation of appeals process for all assigned denied professional service claims.
• Communicates with providers regarding coding denial issues.
• Ensures documentation supports CPT, Modifiers, HCPCS and ICD-10 codes for submitted appeals, reopenings, reconsiderations, etc.
• Serves as a subject matter expert for assigned specialty.
• Utilizes appropriate coding software and coding resources in order to determine correct codes.
• Communicates billing related issues to assigned supervisor/manager.
• Follows departmental policies for charge corrections.
• Provides feedback to providers or appropriate office liaison in order to clarify and resolve coding concerns.
• Submits appeals for assigned payer and/or division.

Ambulatory Coder, Denials

Supply Chain

• Accountable for managing assigned inventories through various cycle counts
• Maintains communication with supported customers
• Monitors supplies usage and removes obsolete products
• Adjusts quantities and locations when necessary
• Records and reports discrepancies
• Manages perpetual and par inventories
• Provides accountability for supply inventories and monitoring volumes
• Analyzes product usage
• Anticipates supply needs and communicates potential interruptions
• Evaluates and analyzes bulk buy discount opportunities
• Maintains ERP system supplies database
• Functions as Informatics Liaison for training users
• Independently makes decisions and takes action regarding supply shortages
• Responsible for the maintenance and operation of automated point-of-use systems

Inventory Control Analyst

• Responsible for validating/reviewing front end coding edits and assigning applicable CPT, ICD-10, Modifiers and HCPCS codes for inpatient, outpatient and physicians office/clinic settings.
• Adheres to all coding and compliance guidelines.
• Communicates with providers and team members regarding coding issues.
• Validates/reviews codes for assigned provider(s)/Division(s) based on medical record documentation.
• Utilizes appropriate coding software and coding resources in order to determine correct codes.
• Responsible for resolving all assigned pre-billing edits.
• Communicates billing related issues to assigned supervisor/manager and participates in meetings to improve overall billing process.

Ambulatory Coder I, Cardio

Analyst

• Provides analysis of workflow, recommend solutions and implements application solutions to meet department needs.
• Translates department requirements into business functional requirements.
• Performs a variety of duties related to Epic and other information technology applications as assigned.
• Assists with design, development, system configuration, implementation and support of assigned Epic applications for the organization.
• Responsible for planning, training and evaluation of application functionality.
• Works with the team and key customers to ensure appropriate development of training and implementation of application functionality.
• Performs in-depth analysis of workflows, data collection, report details, and other technical issues associated with Epic software.
• Investigates end users’ preferences while making build decisions and analyses business operations as they relate to build decision.
• Builds and maintains Epic application content as assigned by department lead/manager.
• Stays current with new application functionality and enhancements.
• Follows functional specification documents to create content within the Epic application.
• Completes thorough unit testing of all build prior to handoff for functional and/or integrated testing.
• Documents and reports system issues through internal chain of command; communication with vendor where appropriate.
• Populates databases during the initial system build with assistance from Epic.
• Collects information regarding potential system enhancements and functionality needs.
• Prepares details of specifications as needed.
• Analyzes data conversion needs and ensures that data coming across an interface into an Epic application meets the business need.
• Develops and documents project team procedures for implementing system changes and other tasks.
• Establishes change control processes and procedures for the system.
• Participates in training development and delivery to end users.
• Works with end users to troubleshoot problems and investigate questions from end users.
• Works with report writers to ensure that the application has the necessary reports.
• Prioritizes and implements requested changes to the system and analyzes new functionality in releases to determine how it should be used.
• Maintains regular communication with Epic representatives and works with the Epic representatives and GHS' end user community to ensure the system meets the organization’s needs.
• Provides end user support during implementation; able to serve as an application expert to assist in application roll-out.
• Applies proven communication, analytical and problem-solving skills to help identify, communicate and resolve system issues to maximize system potential.

Epic Analyst

• Manage and oversee assigned sponsored programs during the award life cycle
• Project financial administration, billing, collection, reporting, closeout, and audits
• Provide high-level customer service to Principal Investigator (PI) and their delegates
• Serve as primary liaison with the sponsor
• Prepare and submit invoices to sponsors
• Analyze and resolve problems related to administration and compliance
• Ensure timely closeout of projects to defined standards

Epic Analyst, Revenue Cycle

• Lead position in analyzing clinical, business and/or technical processes.
• Formulates and develops recommendations for new and modified systems.
• Provides advanced technical expertise in developing systems and procedures.
• Gathers and works with departments to prioritize development initiatives and activities.
• Provides analysis of workflow, recommends solutions, and implements application solutions.
• Manages system upgrades and large projects.
• Responsible for oversight of assigned Epic modules, workflows, and system configuration.
• Mentors Associate and Mid-level I/S Analysts in their roles.

Senior Epic Analyst, Hospital Billing

• Reviews, negotiates, and manages contracts for ancillary services including but not limited to Ambulatory Surgery Center, Urgent Care, imaging, and infusion.
• Requires strong financial, analytical, contract language knowledge, and negotiation skills to support the strategic business goals of the organization.
• Negotiates and maintains contracts including but not limited to all ancillary services required by all payer types in which Prisma Health participates.
• Contributes to the execution of strategic JV initiatives aligned with the organization’s goals.
• Conducts market and competitive data analysis to inform key decision-making and positioning strategies.
• Monitors and reports on key contractual financial performance indicators.
• Possesses a strong understanding of healthcare, contract law, and market factors to ensure network compliance, cost savings, and high-quality patient care within specified time frames in collaboration with key stakeholders.
• Performs detailed analyses of the financial and operational impact of procedural changes implemented by payers.
• Creates and implements educational presentations for changes being implemented by Payor for organizational departments.
• Collaborates with and trains department team members in assisting with managing the processing of all ancillary payer contracts and amendments including language, reimbursement methodology review, and contracting.
• Conducts proactive communication, contract compliance, and educational sessions.
• Develops and maintains effective relationships with payers and internal customers.
• Performs other duties as assigned.

Ancillary Contract Administrator

Security Engineer

• Lead position in analyzing clinical, business and/or technical processes and problems
• Provides advanced technical expertise in identifying, evaluating and developing systems and procedures
• Gathers and works with departments to prioritize development initiatives and activities
• Manages system upgrades and large projects
• Responsible for oversight of assigned Epic modules, workflows and system configuration

Senior Epic Analyst, Security

• Responsible for procurement of stock and non-stock products, services and equipment
• Placement of purchase orders with approved suppliers or in compliance with GPO contracts
• Tracks purchases and responsible for follow-up and expediting purchase orders
• Acts as liaison between customer and supplier
• Analyzes trends and data, collaborates with vendors to meet needs
• Purchases goods, services and subcontractor services
• Verifies accuracy of Purchase Order information
• Tracks, expedites, and coordinates deliveries
• Collaborates with teams/customers and suppliers for timely issue resolution
• Prepares and submits required reports on time
• Uses computer systems and software for processing orders and invoices

Supply Chain Buyer

• Validates/reviews codes for assigned provider(s)/Division(s) based on medical record documentation
• Adheres to all coding and compliance guidelines
• Responsible for resolving all assigned pre-billing edits
• Communicates billing related issues and participates in meetings to improve overall billing process

Ambulatory Coder II – Professional Billing

Financial Planning and Analysis

• Understands organizational goals for timely resolution of accounts
• Works in accordance with Patient Friendly standards
• Collects deductibles, co-pays, and self-pay payments
• Conducts demographic and financial assessments
• Collaborates with Social Work and Outcomes Management
• Interviews patients to obtain demographic and financial information
• Possesses knowledge of computer systems and financial counseling processes
• Ensures elimination of all possible payor sources prior to hospital sponsorship consideration
• Communicates patient's estimated financial responsibility and requests payment
• Receives payments and issues receipts according to departmental procedures
• Monitors high dollar accounts for complete and accurate information
• Initiates authorization and insurance verification processes
• Coordinates referrals for applications to Department of Health and Human Services
• Demonstrates superior interpersonal relationship skills
• Maintains revenue cycle knowledge
• Explores possible payor options
• Participates in departmental training and career development

Patient Financial Specialist

• Lead position in analyzing clinical, business and/or technical processes and problems and formulating and developing recommendations for new and modified systems that meet client and/or internal project requirements.
• Provide advanced technical expertise than that of an Application Analyst in identifying, evaluating and developing systems and procedures that are cost effective and meet user requirements.
• Manage system upgrades and large projects.
• Responsible for oversight of assigned Epic modules, workflows and system configuration.
• 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.
• Accepts final responsibility for testing and debugging software before final deployment.
• Functions as the primary technical liaison with the respective vendor(s) for all implementation and post implementation activities of specific Epic modules.
• Investigates, identifies and prepares proposals to solve specific operational problems with all clinical operational areas.

Senior Epic Analyst, Ambulatory

Auditor

• Responsible for leading coding teams, coder training, work queue management, performing prebill and second-level coding reviews utilizing auditing tools and applicable software.
• Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership.
• Employs critical thinking skills to alert coding leadership to any trends identified in their reviews and to make suggestions for continual process improvement.
• Maintains knowledge of CPT and HCC documentation requirements to ensure correct code assignment.
• Performs outpatient coding by assigning ICD-CM, CPT codes and appropriate modifiers.
• Reviews and responds to outpatient level denials as needed.
• Conducts review of outpatient records to include, GI, outpatient surgery, emergency department records, observation, diagnostic, Interventional Radiology and other identified records to validate the code assignment according to official coding guidelines as supported by the clinical documentation in the record.
• Monitors and maintains work queues daily to identify, prioritize and assign accounts that need to be coded based on department-specific guidelines and within designated timelines coordinating with leadership.
• Mentors and trains coders on application of correct ICD-CD and CPT guidelines.
• Assists with and develops educational programs for coding staff, clinical documentation staff and medical staff to including yearly coding/CPT updates.
• Codes outpatient records periodically based on review of clinical documentation.
• Identifies physician query opportunities following established guidelines when existing documentation is unclear or ambiguous following American Health Information (AHIMA) guidelines and established policy.
• Identifies and assists management with the resolution of coding issues, process improvement and system testing for Health Information Management (HIM) applications.
• Participates in on site, remote and/or external training workshops and training.
• Maintains working knowledge of Centers for Medicare & Medicaid Services (CMS) regulations and applicable carrier local medical review policies.
• Collaborates with Coding leadership to develop and maintain coding curriculum and training handbook.
• Interacts and assists with other departments to resolve coding issues.
• Performs other duties as assigned.