Stanford Health Care

Systems Engineer

• Supports core functions of Stanford Health Care's Billing applications to enable cost-effective and efficient revenue cycle functions.
• Implement, administer, and support the Epic Resolute billing module along with other assigned systems under the minimal guidance of senior members of the team.
• Independently address issues and design decisions of moderate to high complexity with little or no supervision.
• Deliver clear communication and documentation of complex concepts and issues related to applications, interfaces, data structures, and workflows across the organization.

Senior Clinical Systems Analyst – Epic Billing Systems

Director

• Acts as Chair of Denial Prevention committee
• Provides strategic direction and decision-making for denials prevention and management activities
• Stewards the performance of critical KPIs related to denials performance
• Directs and prioritizes multiple enterprise strategic initiatives related to denials reduction and prevention
• Approves and facilitates complex denials management operations
• Creates materials for and actively facilitates monthly Denials Prevention Task Force sessions

Director – Denials Management

• Provide tier-2 support of application incidents reported through the help desk
• Provide analytical assistance to junior team members to resolve application incidents, maintenance items, and enhancement requests
• Coordinate application support with other IT teams
• Implement changes using documented procedures that comply with the department’s policies
• Mentor junior staff members to document workflows

Lead Clinical Systems Analyst – Epic Billing Systems

Program Manager

• Manages daily Compliance Program Management operational activities
• Assists in the development and maintenance of a robust compliance program for Stanford Health Care
• Overseeing and conducting compliance investigations and providing compliance-related guidance
• Organizing, facilitating, and managing the annual Compliance Risk Assessment and Workplan processes
• Developing and delivering Compliance Program Management training
• Producing and maintaining Compliance Program activity records, analytical reports and dashboards

Manager – Compliance Program Management

Manager

• Manages both hospital and professional customer service departments and assists in integrating them into one
• Manages the schedules, performance and work products/services of the Customer Resolution Specialists and Financial Assistance Specialist
• Serves as a resource for both customers and revenue cycle personnel to expediently address and resolve billing and collections questions and/or concerns
• Maintains a complete record of current policies and procedures followed by staff in the manager's areas of responsibility; responsible for having complete knowledge of the patient flow and steps taken by staff to complete these procedures
• Assures that staff is adequately trained and meets competency requirements and levels
• Develops goals and priorities, and assigns tasks and projects
• Develops staff skills and training plans
• Counsels, trains and coaches assigned staff
• Implements corrective actions and conducts performance evaluations
• Provides leadership, direction and guidance
• Represents the department on various committees; conducts regular unit staff meetings
• Responsible for designing, developing, and monitoring of performance improvement processes
• Manages implementation of standards and systems to enhance quality, consistency, efficiency, and timeliness of responsibilities for the enterprise on a 24/7 basis
• Monitors to ensure that integrity and accuracy of registration data is maintained by the staff supervised
• Works collaboratively with other departments to ensure the processes and systems for registration are standardized and optimized for efficient and effective flow of patients within the department and the organization
• Oversees payment plans and other credit procedures, bad debt write-offs, and processing of bankruptcies
• Through leadership and by example, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements
• Manages multiple projects in a timely and efficient manner

Manager – Self-Pay Resolution

Human Resources

• Receives, stores, issues or delivers equipment or supplies
• Takes inventory, reconciles inventory discrepancies
• Ships items for return or repair
• Controls traffic in and about receiving dock
• Carries or uses materials handling equipment to deliver supplies to proper locations

Materials Assistant I – Dock Services

Analyst

• Conduct thorough analyses of denials, evaluating the appropriateness of medical services and procedures.
• Ensure accurate coding with ICD, HCPCS, CPT codes, as well as APC and DRG assignments, while identifying instances of overpayments and underpayments.
• Maintain accurate records of appeals and denials for tracking and reporting purposes.
• Independently compose professional and comprehensive appeal letters to payors after a detailed review of medical records.
• Create comprehensive appeal strategies based on relevant guidelines and documentation to effectively address denials.
• Draft and submit detailed appeal letters along with supporting documentation, ensuring adherence to regulatory requirements and payor guidelines.
• Provide a thoughtful appealability score for each denial under review, assessing the likelihood of a successful appeal.
• Review and edit appeals for clarity and accuracy prior to submission to ensure high-quality presentation.
• Work closely with clinical teams, coding specialists, physicians and other departments to gather necessary information and clarify clinical documentation to support appeals.
• Identify and escalate denial patterns to the Manager of Government Audits and Appeals, providing detailed information for follow-up and resolution.

Clinical Government Audit Analyst, Appeal Specialist II – RN

• Assists in the performance of the operational aspects of a designated unit(s)
• Supervises the provision of quality, therapeutic and cost-effective patient care
• Assists Patient Care Manager in administrative/management functions
• Coordinates and directs the unit(s) patient care operations for an assigned shift
• Facilitates orientation, training and ongoing staff development
• Participates in unit goal and program planning, development, and evaluation of programs

Assistant Patient Care Manager – Cath Lab

• Communicates with Psychologists, Neuropsychologists and related hospital personnel
• Ensures confidentiality of test results and recommendations; maintains security of testing materials
• Explains testing procedures and objectives to patients, and works with patients to facilitate compliance with protocol and procedures to ensure appropriate test completion
• Administers selected neuropsychological tests and test batteries to patients to measure clinical factors such as intellectual functioning, presence and extent of organic involvement, personality characteristics, and psychopathology

Psychometrist, Neuropsychology – Full Time

Translator

• Provide in-person (IP) consecutive and simultaneous interpretation as assigned
• Provide consecutive interpretation via video or phone
• Provide sight translation following standard workflow and ethical guidelines
• Document encounters in electronic medical record (EMR) system according to departmental standards

Medical Spanish Interpreter/Translator I

• Oversees the day-to-day technical operations of the Radiation Therapy department
• Collaborates with senior leadership to develop and implement strategic business and marketing plans
• Manages the delivery of radiation therapy services across multiple sites
• Develops and maintains policies and procedures for area(s) of responsibility
• Monitors expenses for cost centers and analyzes referral, volumes, and patient satisfaction data.

Manager, Radiation Oncology

• Conduct thorough analyses of denials, evaluating the appropriateness of medical services and procedures.
• Maintain accurate records of appeals and denials for tracking and reporting purposes.
• Independently compose professional and comprehensive appeal letters to payors after a detailed review of medical records.
• Create comprehensive appeal strategies based on relevant guidelines and documentation to effectively address denials.
• Draft and submit detailed appeal letters along with supporting documentation, ensuring adherence to regulatory requirements and payor guidelines.
• Provide a thoughtful appealability score for each denial under review, assessing the likelihood of a successful appeal.

Clinical Government Audit Analyst, Appeal Specialist II

• Responsible for day-to-day operations of radiation oncology care delivery
• Develop and manage administrative, fiscal, nursing, and technical resources
• Ensure compliance with external regulatory organizations
• Develop operating budgets and strategies for cost control
• Collaborate with clinical leadership on quality and patient safety

Director, Radiation Oncology Network – Nursing

• Inpatient & SNF Utilization Management & Care Coordination: Support proactive hospital discharge planning, transfers, and redirections through collaborative care planning.
• Develop individualized care plans for all complex case management patients, including regular updates with distribution throughout the care team.
• Proactively interface with HMOs, physicians, internal staff and family members to assist in developing a well-rounded care plan.
• Complete health risk assessments for selected senior patients as needed.
• Serves as a liaison between hospital, health plan, providers, caregivers, family, and the patient.
• Identify opportunities to improve utilization, quality of care, access issues and physician profiling.
• Acts as a resource for provider and patient education as necessary.
• Reduce avoidable inpatient and SNF bed days through telephonic & in person concurrent review, proactive assessment of barriers to discharge, and collaboration with key parties (health plan, facility, provider office, member and family) to facilitate safe and timely discharge or transition.
• Apply standard clinical criteria, document decisions and issue related member and/or provider correspondence.
• Ensure seamless and safe transition of care, through inpatient and SNF bed-side visits, post discharge coordination with members, providers and ancillary services, including related bedside visits, post-discharge calls and/or visits to members.
• Referral to telephonic case management, if appropriate.
• High Risk Member Complex Case Management: Proactively review Health Risk Assessments and at-risk patient populations for identification of patients appropriate for case management.
• Provide regular feedback to providers, inpatient case managers, and utilization management coordinators on the appropriateness of complex case management referrals.
• Develop and implement care coordination services for complex patients as needed, including scheduling appointments, home health, DME, transportation, financial assistance, and linkages with community resources.
• Identifies and refers high-risk members to delivery system chronic disease care programs to improve quality of care.
• Maintains daily electronic case management case list.
• Attends weekly interdisciplinary care team meetings to discuss complex cases and integrate input from the entire team.
• Meet production standards: Adheres to all SHC Health Plan policy and procedures
• Manages caseload of approximately 50-150 complex and/or rising risk case management patients.
• Provide telephonic and/or onsite case management for members requiring a higher level of complex case management which may include periodic visits at the member’s home or provider settings
• Complete comprehensive assessment of clinical & non-clinical risk factors impacting member’s health status.
• Develop and coordinate implementation of individualized, member centered care plans, involving member, care givers, providers and other stakeholders to ensure alignment, including scheduling appointments, home health, DME, transportation, coordinating financial assistance, and linkages with community resources.
• Effective coordination and communication with Medical Directors and clinical staff.
• All other duties as assigned including department-specific functions and responsibilities: Meet departmental review and documentation standards for work assignments. Adhere to the policy and procedure of assigned hospital(s).
• Build and maintain appropriate relationships on behalf of SHC Health Plan.
• Attend departmental and company meetings as indicated by management. Includes developing and/or presenting reports to Board directors, health plans, medical groups and other committees.
• Performs other duties as assigned and participates in organization projects as assigned.
• Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.