Prisma Health

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

Customer Service Representative

Financial Planning and Analysis

• 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
• Monitors denial work queues and reports in accordance with assignments from direct supervisor
• Communicates all denial trends, denial increases, etc. to direct supervisor/PFS management
• Participates in departmental huddles and team meetings involving discussion of A/R processes and denial trends
• Maintains required levels of productivity and quality while managing tasks in work queues to ensure timeliness of follow-up and appeals
• Organizes denial/rejection related tasks to identify patterns and/or work most efficiently
• Identifies and monitors negative patterns in denials/rejections
• Escalates accordingly to PFS management and the impacted department(s) to avoid negative impact on reimbursement, unsuccessful appeals, and/or increased write-offs
• Works with other departments to resolve A/R and payer issues
• Enters and documents appropriate accounts for adjustments utilizing the appropriate adjustment codes
• Identifies and researches all payer issues to the Payer SharePoint in a timely manner and continues to follow-up on said SharePoint information on a weekly basis
• Performs other duties as assigned

Patient Financial Services Denials and Appeals Specialist

Medical Billing and Coding

• 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
• Performs other duties as assigned.

Ambulatory Coder III, Ortho

Analyst

• Analyzes clinical, business and/or technical processes and problems to formulate and develop recommendations for new and modified systems that meet client and/or internal project requirements.
• Provides technical expertise 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 functional areas including nursing, ancillary departments, Physician practices, patient accounting, medical records, finance, human resources, purchasing, sales, and contracts.
• Manages system upgrades and other small projects.

Associate Application Analyst – Communication Outreach Engagement and Experience Team

Software Engineer

• 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.
• 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.
• Gains 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.
• Fosters strong collaborative relationships with various Epic application teams across the organization to share insights, gather requirements, and identify opportunities for improved reporting solutions.

Epic Intelligence Developer

Security Engineer

• 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
• Analyzes data conversion needs and ensures that data coming across an interface into an Epic application meets the business need
• Participates in training development and delivery to end users

Epic Analyst, Community Connect Reporting, Security

Translator

• Interprets spoken words from one language to another.
• May be designated according to language or languages interpreted.
• May specialize in specific subject area.

Interpreter, Spanish, PT, Variable

Support Engineer

• 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 Tier 1 issues using troubleshooting resolution matrix.
• Gathers 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.

Support Analyst, MyChart Support

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

• 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

• 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