Prisma Health

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.
• Responsible for data analysis and interpretation throughout all functions of revenue cycle.
• Resolves billing concerns, addresses inquiries related to insurance concerns/matters.
• Reviews accounts to determine insurance coverage; obtains and corrects any missing or inaccurate information.
• Discusses patient responsibility, which includes educating patients on claim processing.
• Interacts with patients by informing about payment options such as payment plans and financial assistance.

Billing Office Customer Service Specialist

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
• Serves as a subject matter expert for assigned specialty
• Communicates with team members regarding coding denial issues and trends
• Responsible for working coding claim denials accurately and timely in accordance with performance and productivity goals
• 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 III

Analyst

• Analyzes clinical, business and/or technical processes and problems.
• Provides technical expertise in identifying, evaluating and 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.
• 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 other small projects.
• Creates and maintains reports to support assigned departments.
• Communicates with assigned departments and acts as the hub of communication.
• Investigates, identifies and prepares proposals to solve specific operational problems.
• Develops a timeline for implementation and ensures closure of outstanding issues.

Application Analyst

Manager

• Executes and provides leadership to teams for operational and strategic planning related to revenue cycle systems, including business requirements, project planning, budgeting, performance optimization, and resource allocation.
• Ensures revenue cycle ITS resources and initiatives are aligned with organizational strategic objectives and regulatory requirements.
• Leads operational and strategic planning for revenue cycle systems, including budgeting, forecasting, and resource management.
• 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, ensuring alignment with business processes and strategic vision.
• Key decision-maker for complex issues involving revenue cycle systems and workflows.
• Partners with ITS and operational departments to define system requirements and implement solutions that enhance efficiency and customer service.
• Develops and executes plans for financial systems strategy in coordination with leadership and governance structures.
• 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, Billing

Insurance

• Verifies insurance coverage/benefits utilizing online eligibility, websites, or by telephone inquiry to the insurance administrator and/or third-party payor.
• Information obtained through insurance verification must always be documented accurately and completely in the EPIC patient billing system.
• Ensures insurance priorities are correct based on third-party requirements/COB.
• Identifies current patient responsibility using insurance eligibility and benefit responses.
• Documents patient responsibility as required according to Departmental Guidelines to help ensure correct patient payments are collected at time of service.
• Initiates, obtains, and documents pre-certifications /prior authorizations as required according to Departmental Guidelines.
• Communicates new insurance system issues to appropriate personnel to be reviewed/corrected.
• Manually corrects/updates current identified insurance issues according to departmental guidelines until correction can be implemented.
• Performs other duties as assigned.

Insurance Pre-Registration Representative

• 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.
• Provides more 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.
• Gathers and works with departments to prioritize development initiatives and activities.
• Provides analysis of workflow, recommends solutions, and implements application solutions to meet departmental needs.
• Translates departmental requests into business functional requirements.
• Performs financial analysis/business plan/impact assessment.
• 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.
• Ability to perform a variety of complicated tasks and may lead and direct the work of others.
• 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 and supervises work efforts as directed.

Senior Epic Ambulatory 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.
• 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 in 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, Orders

• Provides analysis of workflow, recommend solutions and implements application solutions to meet department needs.
• Performs a variety of duties related to Epic and other information technology applications as assigned.
• Responsible for planning, training and evaluation of application functionality.
• Investigates end users’ preferences while making build decisions and analyses business operations as they relate to build decision.
• Prepares details of specifications as needed.

Epic Analyst, Cadence

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 utilized by leadership and management
• Publish quality analytics to include weekly or monthly dashboards, productivity, ad-hoc projects, and KPIs
• Maintain system databases to reflect changes in the drug formulary or product specifications
• Participate in improvement initiatives and develop data extracts needed to identify weaknesses and opportunities

Business Data Analyst – Pharmacy

• Supports the Prisma Health Trauma Program and organizational requirements for verification/designation as a Trauma Center.
• Responsible for all aspects of the Trauma Registry Data including abstraction, entry, and coding.
• Applies comprehensive knowledge to identify and collect complex data on trauma patients.
• Performs ICD-10 coding and AIS coding of all diagnoses and procedures.
• Utilizes critical thinking, organization, and time management skills to achieve high productivity and accuracy.

Trauma Registry Analyst, PT, Day

• Responsible for abstracting and validating CPT, ICD-10 and HCPCS codes for inpatient, outpatient and physician's office/clinic settings.
• Adheres to all coding and compliance guidelines.
• Maintains knowledge of coding/billing updates and payer specific coding guidelines.
• Serves as a subject matter expert for assigned specialty.
• Abstracts/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.
• Communicates billing related issues to assigned supervisor/manager and participates in meetings in order to improve overall billing, when applicable.
• Follows departmental policies for charge corrections.
• Provides feedback to providers in order to clarify and resolve coding concerns.
• Resolves assigned pre-billing edits.
• Assists in identifying areas that require additional training.
• Mentors and assists in training other coders and new team members.
• Performs other duties as assigned.

Ambulatory Coder III, Cardio

• Responsible for abstracting and validating CPT, ICD-10 and HCPCS codes for inpatient, outpatient and physician's office/clinic settings.
• Adheres to all coding and compliance guidelines.
• Maintains knowledge of coding/billing updates and payer specific coding guidelines.
• Serves as a subject matter expert for assigned specialty.
• Utilizes appropriate coding software and coding resources.
• Communicates billing related issues to assigned supervisor/manager.
• Participates in coding educational opportunities.
• Provides feedback to providers to clarify and resolve coding concerns.
• Resolves assigned pre-billing edits.
• Mentors and assists in training other coders and new team members.

Ambulatory Coder III, OBGYN

• Responsible for abstracting and validating CPT, ICD-10 and HCPCS codes
• Adheres to all coding and compliance guidelines
• Maintains knowledge of coding/billing updates and payer specific coding guidelines
• Serves as a subject matter expert for assigned specialty
• Utilizes appropriate coding software and resources to determine correct codes
• Communicates billing related issues to assigned supervisor/manager

Ambulatory Coder III, Professional Billing

Translator

• Interprets spoken passages from one language into another.
• In consecutive interpreting listens to complete statements in one language, interprets to second, and interprets responses from second into first language.
• Expresses either approximate or exact interpretation.
• Receives briefing on subject to be discussed prior to interpreting session.
• Responds to all customers, sets priorities, gives reports and maintains confidentiality.
• Provides information, education and technical assistance for customers in order to help facilitate effective use of language services.
• Maintains positive working relations with all customers and peers including verbalizing complaints or concerns through appropriate channels and accepting assignment.
• Performs other duties as assigned.

Interpreter, American Sign Language

• Interprets spoken words from one language to another