Prisma Health

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

Patient Financial Services Denials and Appeals Specialist

Ambulatory Coder III, Ortho

Associate Application Analyst – Communication Outreach Engagement and Experience Team

Epic Intelligence Developer

Epic Analyst, Community Connect Reporting, Security