University Hospitals

Medical Billing and Coding

• Under the direction of the Revenue Cycle Supervisor - Coding the Physician Coding Specialist II monitors and analyzes unresolved third party accounts for multi-specialty group practices.
• Analyzes outstanding insurance accounts on a daily basis and in accordance with established time frames.
• Initiates appropriate and effective telephone and/or written follow-up on the identified accounts.
• Communicates with payors and other internal departments to obtain critical information impacting claim resolution.
• Researches and responds to all inquiries from the customer service department in a prompt, professional manner.
• Reviews and corrects coding edits and denials.
• May code ICD-10 from written documentation and abstract CPT/HCPCS codes.
• May perform computer assisted coding functions.
• Consistently meets department productivity and quality standards.
• Maintains patient/physician confidentiality and effective communication with patients and physicians.
• Provides information and feedback to various personnel within UHPS.

Physician Coding Specialist II

• Responsible for accurately and timely coding of outpatient and professional medical records following established coding, CMS regulations and hospital guidelines.
• Reviews all types of encounters and accurately codes diagnostic and procedural information following coding guidelines and regulations information including, facility specific guidelines and federal regulations.
• Responsible for accurately coding hospital ancillary, ED, same day surgery, observation and/or professional physician services encounters.
• Maintains productivity and quality rate according to established standards.
• Ensures optimal CPT /ASC/APC/APG assessment.
• Understanding and ability to resolve coding specific edits such as CCI, LCD, NCD and MUE.
• Works within UH billing time frames.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars.
• Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
• Maintains up to date credentials.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
• Participates in educational and informational activities.
• Performs other duties as assigned.
• Complies with all policies and standards.

Outpatient Coding Specialist I

• Analyzes, on a daily basis and in accordance with established time frames, the outstanding insurance accounts.
• Initiates appropriate and effective telephone and/or written follow-up on the identified accounts.
• Communicates with payors and other internal departments as required to obtain critical information that impacts the resolution of both current and future claims.
• Researches and responds to all telephone inquiries from the customer service department, in a prompt, professional manner meeting departmental guidelines.
• Reviews and corrects coding edits and denials.
• May code ICD-10 from written documentation.
• May abstract CPT/HCPCS codes.
• May perform computer assisted coding functions.
• Working knowledge of coding rules and payer guidelines.
• Consistently meets department productivity standards.
• Consistently meets department quality standards.
• Maintains patient/physician confidentiality at all times and maintains effective communication and professional interaction with patients and physicians.
• Provides appropriate information and feedback to various personnel within UHPS.
• Supports and utilizes established departmental guidelines.
• Recommends additional research to other CBO departments.
• Identifies trends with insurance related issues and reports findings to the Team Lead.
• Acts as a role model for professionalism through appropriate conduct and demeanor at all times.
• Interprets written correspondence and either resolves the problem or forwards it to another department for prompt resolution.
• Effectively communicates utilizing the telephone, form letters or internal correspondence to resolve patient inquiries.
• Handles multiple tasks simultaneously.
• Must have an understanding of insurance products and billing requirements to effectively resolve discrepancies in billing statements.
• Performs other related duties as assigned.

Software Engineer

• Designs and develops reports using Microsoft SQL Reporting Services platform (SSRS), MS Excel, Pivot tables, SharePoint and other intuitive graphical add-on tool sets.
• Ensures report products are efficient and meet all regulatory and security requirements.
• Develops data extraction and output specifications for reports based on analysis of end user’s requirements.
• Gathers specifications from internal customers to understand requirements analyze data and provide valid report designs.
• Identifies appropriate data sources for customer requests and ensures data integrity when pulling information into structured reports.
• Implements report subscriptions and methods for report distribution based on agreed timelines and according to specifications.
• Coordinates with vendors and DBA team in scheduling jobs and processes.
• Retrieves data from a variety of database types utilizing available tools as required.
• Actively supports and maintains the reporting platform including troubleshooting environment issues and preparation for service packs and upgrades in conjunction with the DBA team.
• Proactively identifies and address scalability and performance bottlenecks to support the database environment.
• Performs quality assurance testing of reports and facilitates user acceptance testing (UAT).
• Ensures quality of the reports prior to releasing to production.
• Develops and maintains documentation templates and standards for documentation of data extraction and output specifications, reports and other requirements.

Report Developer – Institutional Relations and Development

Medical writer

• Ensures documentation is accurate and complete by performing timely medical record review and determination of code assignment by applying clinical and/or coding expertise to identify opportunities for improved or clarified documentation that accurately reflects the patient.
• Direct and timely follow-up with clinical providers to ensure requested clarification is provided.
• Responsible and accountable for expanding CDI and coding knowledge (keeping up to date on latest research, technology, treatment modalities, etc.)
• Actively engages in educating physicians and other clinical care providers regarding clinical documentation in a variety of formats including participation in clinical rounding, service line focused education sessions and one to one case specific feedback.
• Applies knowledge of health care workflows in order to work collaboratively with medical staff and other health care team members to improve the overall accuracy and comprehensiveness of medical record documentation, with focus on ensuring accurate reporting of quality outcomes.
• Meets established operational and productivity standards. Consistently meets productivity, quality, and AHIMA ethical standards.

Clinical Documentation Integrity Specialist

• Serve as an advisor and expert resource for providers to improve the accuracy of clinical documentation to support patient complexity, risk profiles and appropriate E/M levels
• Assist providers in identifying clinically relevant information and capturing the clinical documentation needed to accurately reflect patient acuity
• Focus on the recapture and identification of chronic conditions reflected in Hierarchical Condition Categories (HCCs)
• Complete pre-visit and post-claim reviews as well as providing clear communication and education to providers on their documentation, coding and billing practices
• Coordinate with colleagues from the CDI Program or other members of the organization regarding education and training geared towards improving clinical documentation

Clinical Documentation Specialist

• Applies clinical expertise and knowledge of health care workflows in order to educate and train CDI Specialists in the essential duties of their role to improve the overall accuracy and comprehensiveness of medical record documentation, with focus on ensuring accurate reporting of quality outcomes
• Educates CDI Specialists on the rules/regulations associated with coding and clinical documentation integrity.
• Trains newly hired CDI Specialists and provides ongoing coaching and education specific to daily CDI Specialist job functions.
• Ensures the work output of the Clinical Documentation Integrity staff is accurate and compliant.
• Collaborates with CDI leadership and Coding team to identify training opportunities and assist with education of CDI and Coding staff with regard to clinical documentation integrity and/or clinical and coding scenarios as needed.
• Performs post-discharge, final coded, pre-bill reviews of targeted records identified for second-level review for opportunity to accurately capture patient acuity, severity of illness, risk of mortality, and DRG assignment in compliance with industry rules and regulations.
• Documents SLR findings within CDI application.
• If a documentation opportunity is identified, place physician query and follow up for response to ensure completeness and accuracy of the medical record.
• If coding opportunity is identified, coordinate with coder and/or Coding Leadership to review and address opportunity as applicable.
• Serves as a role model and resource for CDI team members.
• Subject matter expert that exhibits excellent skills in essential components of the CDI Specialist role.
• Responds to CDS requests for concurrent chart reviews on challenging cases with recommendations and supporting rationale.
• Performs concurrent second level reviews based on defined criteria and shares feedback with CDI Specialist assigned to the encounter for action on opportunities identified.
• Maintains a summary of opportunities identified through second level review for feedback and education with the CDI team.
• Coordinates with other Second Level Reviewers, CDI Leads, and CDI Educator to compile trends and areas of opportunity and conduct education both 1:1 and group education with the CDI team based on the findings.
• Periodically review the criteria established for cases triggering a second level review and recommend updates or modifications to the criteria to assist in identifying areas of opportunity.
• Is actively engaged in quality and process improvement efforts.
• Performs targeted audits as assigned in support of department initiatives.
• Participates in quality initiatives such as HAC/PSI and US News/Mortality.
• Collaborates with CDI Leadership, Leads and Educators to optimize query templates.
• Identifies and shares feedback regarding workflow improvement opportunities identified when completing the SLR process.
• Facilitates change and supports the CDI team through change management processes.
• Actively engages in advancing the CDI practice throughout the UH enterprise.
• Actively engages in department and/or enterprise-wide committee.
• Performs other duties as assigned. Complies with all policies and standards. For specific duties and responsibilities, refer to documentation provided by the department during orientation.

Clinical Documentation Integrity Analyst

Clinical Research

• Coordinate and manage the regulatory operations for clinical research studies conducted by principal investigator(s) at University Hospitals Case Medical Center (20%)
• Complete regulatory documentation required to conduct clinical research with the IRB, pharmaceutical sponsor, and other internal/external agencies or committees (20%)
• Coordinate and perform study specific regulatory processes across multiple complex studies of different therapeutic areas and phases including IND or IDE held investigator initiated trials (30%)
• Manage regulatory processes to maintain compliance with SOPs, GCP guidelines, sponsor guidelines and current regulations (20%)
• Embraces the principles and practice of leadership and professionalism in clinical research. Provides mentorship and training on the clinical trial and regulatory process to staff members (10%)
• Performs other duties as assigned. Complies with all policies and standards. For specific duties and responsibilities, refer to documentation provided by the department during orientation.

Clinical Research Regulatory Specialist II

Research Analyst

• Works with the Principal Investigator to coordinate all aspects of implementation of assigned multiple and/or complex clinical research trials.
• Responsible for submission of related documents to the appropriate regulatory review committees and maintenance of regulatory files.
• Performs all activities related to clinical research studies including but not limited to: screening participants for eligibility and recruitment, obtains informed consent, educates participants regarding study requirements and completes case report forms (CRF).
• Responsible for in-depth knowledge of protocol requirements and Good Clinical Practice (GCP) guidelines.
• Documents, records and assimilates accurate participant records and study records to ensure documentation compliance with sponsor guidelines, standard operating procedures (SOP) and internal and external regulatory agencies.
• Assists with SOP, grant and protocol development and active participant in preparation of manuscripts and presentations for scientific meetings.
• Establish and maintain communications with Investigator, Sponsor and internal constituents.
• Mentorship of the clinical research process to the junior clinical research staff.

Clinical Research Specialist II, Peds Hematology/Oncology

• Responsible for accurately and timely coding of moderately complex encounters following established coding, CMS regulations and hospital guidelines.
• Accurately codes diagnostic and procedural information following official coding guidelines, facility specific guidelines and federal regulations.
• Reviews moderately complex medical records to identify sequence, code diagnoses and procedures according to established coding, CMS and hospital guidelines.
• Responsible for accurately coding hospital same day surgery, observations, ancillary, ED encounters and/or professional services.
• Ensures optimal CPT, ASC, APC, APG assignment as applicable.
• Understanding and ability to resolve coding specific edits such as CCI, LCD, NCD, and MUE.
• Supports OP Clinical Documentation Improvement program.
• Maintains productivity and quality rate according to established standards.
• Works within UH Billing time frames.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars.
• Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
• Maintains up to date credentials.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).

ProFee Coding Specialist II

• Comprehends knowledge of scientific concepts related to the design and analysis of clinical trials; how drugs, devices and biologicals are developed and regulated.
• Ensures care of the participants, aspects of human subject protections and safety in the conduct of a clinical research study.
• Encompasses study management and GCP compliance; safety management (adverse event reporting) and handling of investigational product.
• Facilitates all elements of communication within the site and between the site and sponsor, CRO and regulators; understands teamwork skills critical to responsible conduct of clinical research.
• Embraces the principles and practice of leadership and professionalism in clinical research.

Clinical Research Regulatory Specialist I

Accounts Payable

• Reconciles supplier statements on a timely basis; effectively communicates and resolves open issues as it relates to missing credit memos, missing invoices, invoices on hold, disputes and invoices inquiries.
• Serves as team lead over an Accounts Payable Specialist to identify and resolve issues related to the entry of all invoices related to the suppliers assigned.
• Performs Electronic Data Interchange (EDI) supplier invoice processing and troubleshooting.
• Performs direct buy and purchase order supplier invoice upload file imports into Oracle on scheduled due dates.
• Analyzes price variance report monthly.
• Analyzes and resolves unapplied credit and debit memos.
• Provide back-up to Accounts Payable Specialist functions.
• Responds to requestor Receipt No Invoice (RNI) follow up notifications within a two-week period.
• Review and correct all applicable aged Accounts Payable invoice holds on a weekly basis.
• Reviews and resolves Markview systems working folder on a timely basis.
• Answers and effectively resolves internal and external phone calls in a timely manner.
• Obtain copies of invoices and credit memos that are missing
• Resolves KTM and Markview backlog queues as assigned by Corporate Accounts Payable Manager.
• Supplier maintenance back-up responsibilities.
• Review supplier payment terms and communicates differences to Corporate Accounts Payable Manager & Supplier Correspondent for necessary updates.
• Assists in opening mail and scanning of supplier invoices into Kofax and Markview systems.
• Resolve invoice variances with the supplier and/or buyer

Senior Accounts Payable Specialist – Hybrid

Compliance

• Under the direct supervision of the Compliance Supervisor or Director and the Chief Compliance Officer, works closely with key stakeholders to implement elements of the UH Compliance and Ethics Program to ensure compliance with new and existing federal, state, and local laws and regulations affecting University Hospitals Health System.
• For assigned areas, perform ongoing activities related to the development, implementation, maintenance of, and adherence to UH policies and procedures and applicable federal, state, and local laws, rules, and regulations, including:
• Chair and coordinate meetings for assigned Compliance Committees.
• Develop and implement compliance activities for assigned areas with the oversight and direction of the UH Compliance and Ethics Department. This includes periodic assessment of compliance related controls, measurement criteria and monitoring activities.
• Identify areas of potential compliance risk and take appropriate measures to resolve that risk.
• Facilitate an environment of open communication allowing employees to report compliance concerns, questions or problems without the fear of retaliation.
• Evaluate the compliance program activities in assigned areas and institute changes/revisions necessary to reflect current laws, regulations and best practices.
• Evaluate compliance risk in assigned areas to recommend specific compliance activities and initiatives for inclusion on the UH annual compliance work plan.
• Ensure that each assigned area has internal controls, monitoring and specialized auditing procedures in place for consistent compliance processes.
• Coordinate and integrate activities and analyses, as appropriate, into assigned area’s quality and risk management program.
• Assist with the execution of the annual compliance work plan for each assigned entity, supportive and consistent with the UH annual compliance work plan, which outlines (according to the compliance risk areas) each assigned entity’s specific compliance activities and initiatives.
• Function as the assigned entities’ Compliance Officer or HIPAA Privacy Officer.
• For the assigned areas, investigate and document all reported compliance issues, including:
• Communicate reported issues as appropriate to the appropriate Director and/or the Chief Compliance Officer.
• Respond and investigate, in a timely manner, all reported questions and compliance issues, including but not limited to reports received through the UH Compliance Hotline that pertain to the assigned areas.
• Maintain documentation, including updating the Compliance Databases, of all investigations, corrective actions, and supporting compliance activities.
• In conjunction with the Compliance and Ethics Department, identify trends in compliance issues and utilize information to design or re-design systems, policies and procedures and training/education to enhance consistent compliance.
• For the assigned areas, educate personnel about the UH Compliance and Ethics program, including:
• Periodically assess assigned area’s overall education needs and identify departments and/or employees who require specialized training to enhance compliance.
• Assist the Compliance and Ethics Department in the development of education and training materials, including articles for newsletters and other communications relating to compliance program activities.
• Facilitate training and education to employees relative to the UH Compliance and Ethics Program and each employee’s compliance responsibilities.
• Assist in the dissemination of compliance information or updates to appropriate individuals within assigned areas.
• For assigned areas, ensure compliance with HIPAA, HITECH, Ohio law relating to confidentiality of health information, and UH policies relating to Protected Health Information, including:
• Assist in compliance/privacy investigations, including detailed data analysis and reporting.
• Investigate compliance issues, analyze findings, and support implementation of appropriate recommendations.
• Perform compliance training and coaching as requested or indicated. Ensure integration and compliance with UH policies and procedures, including:
• Attend and participate in Compliance and Ethics departmental meetings.
• Participate in relevant system activities and processes.
• Identify opportunities for enhancing compliance. Participate in periodic compliance strategic planning and effectiveness evaluations. Keep apprised of compliance and regulatory industry developments, including but not limited to, OIG guidance and annual work plans, advisory opinions, CMS updates, significant billing and coding updates, Stark Law and Anti-Kickback Statute updates. Performs other duties as assigned.

Compliance Officer

• Responsible for accurately and timely coding of outpatient and professional medical records following established coding, CMS regulations and hospital guidelines.
• Reviews patient encounters and assigns diagnostic ICD-10-CM and or/procedural CPT codes according to established coding, CMS and hospital guidelines.
• Responsible for accurately coding hospital ancillary, ED, same day surgery, observation and/or professional physician services encounters.
• Maintains productivity and quality rate according to established standards.
• Ensures optimal CPT /ASC/APC/APG assessment.
• Understanding and ability to resolve coding specific edits such as CCI, LCD, NCD and MUE.
• Works within UH billing time frames.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars.
• Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.