Prisma Health

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

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

Software Engineer

• 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.

Senior Enterprise Intelligence Developer, Full-Time

Medical Billing and Coding

• Codes medical information into the Prisma billing/abstracting systems using established professional and regulatory coding guidelines.
• Ensures that each diagnosis present on admission (POA) indicator is assigned appropriately.
• Codes for multiple facilities.
• Adheres to Prisma Health Coding and Compliance policies and procedures for assignment of complete, accurate, timely and consistent codes.
• Performs Inpatient coding including major traumas and Neonatal Intensive Care Unit (NICU) records by assigning International Classification of Diseases (ICD) and International Classification of Diseases-Procedure Coding System (ICD-PCS) codes as well as the Diagnosis Related Groups (DRG) assignment.
• Abstracts and assigns and verifies codes for Major Complications and Comorbidities/Complications and Comorbidities (MCC/CCs), Hospital-Acquired Condition/Patient Safety Indicator (HAC/PSI) and Quality Indicators capture as appropriate through documentation validation.
• 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.
• Selects the optimal principal diagnoses with appropriate POA indicator assignment and sequencing of risk adjustment diagnoses following established guidelines.
• Reviews work queues to identify charts that need to be coded and prioritizes as per department-specific guidelines and within designated timelines.
• Follows up on On-hold accounts daily for final coding.
• Identifies and requests physician queries following established guidelines when existing documentation is unclear or ambiguous following American Health Information Management (AHIMA) guidelines and established organization policies.
• Ensures all open queries initiated by Clinical Documentation Specialists have been addressed prior to final coding.
• Adheres to department standards for productivity and accuracy.
• Identifies and trends coding issues escalating identified concerns.
• Consults, provides professional expertise to and collaborates with clinical documentation specialists on coding and documentation practices and standards.

Health Information Management Inpatient Coder

Pharmacist

• Leads, oversees and ensures the successful delivery and management of projects/systems within scope, quality, schedule, and cost constraints.
• Collaborates with pharmacy executives and evaluates productivity, communication, and teamwork.
• Helps identify project/system strengths, weaknesses, opportunities, and risks.
• Ensure that the project/system results meet agreed upon business objectives.

Pharmacist - System Specialist

• Analyzes clinical, business and/or technical processes and problems to formulate and develop recommendations for new and modified systems.
• Provides technical expertise in identifying, evaluating and developing systems and procedures that are cost effective.
• 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 functional areas including nursing, ancillary departments, and finance.
• Manages system upgrades and other small projects.

Application Analyst, Clinical Device Integration

• 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
• Communicates billing related issues to assigned supervisor/manager
• Participates in coding educational opportunities (webinars, in house training, etc.)
• 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

Ambulatory Coder III

• 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
• 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
• Assists in identifying areas that require additional training
• Mentors and assists in training other coders and new team members

Ambulatory Coder II, Ortho

• Responsible for validating/reviewing 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.
• Maintains knowledge of coding/billing updates and payer specific coding guidelines for multi-specialty medical practice(s).
• Communicates with providers and team members regarding coding issues.

Ambulatory Coder II, Professional Billing

• 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.
• Assisting with design, development, system configuration, implementation and support of assigned Epic applications for the organization.
• Responsible for planning, training and evaluation of application functionality.
• Responsible for working with the team and key customers to ensure appropriate development of training and implementation of application functionality.

Epic Analyst, Ambulatory

• 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.
• Participates in coding educational opportunities (webinars, in house training, etc.).
• 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.

Ambulatory Coder III, ENT

• 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

Manager

• Manages implementation of practice guidelines of the Vascular Lab department under the guidance of the Director of Operations, Department of Surgery.
• Assumes responsibility for patient care and safety and for the quality of services provided by the department.
• Assists with the development and implementation of departmental aspects of CV Services.
• Responsible for staff in-service and coordination of activities necessary for licensure and accreditation of assigned areas.
• Performs exams as necessary and to maintain working clinical knowledge of vascular procedures in both the inpatient and outpatient setting.

Manager – Vascular Lab

• Responsible for pursuing denied accounts and timely follow-up to address payment delays.
• Updating/reprocessing claims and submitting reconsiderations/appeals within proper filing timeframe.
• Knowledgeable of payer requirements and experienced in claim resolution.
• Identifying, expediting, and escalating trends to management.
• Demonstrating exceptional relationships with external/internal payers and internal departments.
• Monitoring denial work queues and reporting in accordance with assignments from direct supervisor.
• Participating in departmental huddles and team meetings involving discussion of A/R processes and denial trends.
• Maintaining required levels of productivity and quality while managing tasks in work queues to ensure timeliness of follow-up and appeals.
• Organizing denial/rejection related tasks to identify patterns or work efficiently (e.g., by current procedural terminology, diagnosis, payer, etc.).
• Identifying and monitoring negative patterns in denials/rejections and escalating accordingly to PFS management.
• Utilizing identified and known resources to accomplish follow-up on tasks.
• Complying with all government regulatory mandated requirements for billing and collections.

Patient Financial Services Denials and Appeals Specialist

Customer Support

• Handles a large volume of inbound calls
• Makes outbound calls related to self-pay follow up on accounts
• Assists patients with requests for information and complaints
• Resolves billing concerns and assists patients with MyChart
• Reviews accounts to determine insurance coverage and corrects any missing or inaccurate information
• Discusses patient responsibility including educating on claim processing
• Interacts with patients about payment options and sets up payment plans
• Communicates clearly and professionally in both oral and written communication
• Ensures compliance with privacy, HIPAA, and regulatory requirements