University Hospitals

Educator

• Responsible for assuring coding is being performed accurately.
• Is responsible for assessing coding accuracy and completeness of Revenue Cycle coding process/policy and workflows for inpatient and outpatient medical record documentation by conducting random and focused coding reviews; documenting, preparation and timely presentation of results.
• Educates individuals on the rules/regulations associated with coding.
• Functions as lead coding adviser to Coding Specialists and answers all educational questions timely.
• Performs training and quality monitoring of new, established employees and students.
• Responsible for providing timely feedback to the team on the application of coding guidelines, practices, and proper documentation techniques and data quality improvements.
• Performs random coding quality review on monthly basis and provides timely feedback, additional training and education as needed.
• Identifies and trends areas of opportunity for performance improvement for all coders and provides appropriate feedback to management.
• Demonstrates comprehensive understanding of CCs/MCCs, impact on quality reporting, UHDDS guidelines, HACs and PSIs.
• Assists with the analysis of case mix reports and other statistical reports.

Inpatient Coding Educator

Pharmacist

• Access care management documentation systems for data entry and to support the existing programs and processes by collecting information, utilizing appropriate department policies, procedures and guidelines specific to members’ eligibility, benefits and contracts.
• Perform intake of service requests from providers or members received electronically, or via telephone or fax.
• Triage and respond to incoming phone calls providing information and assistance to meet the caller’s needs.
• Authorize service(s) based on plan design or clinical guidelines in accordance with the department policies/guidelines.
• Improve patient service experience and maximize pharmacy revenue through provision of prior authorization services on behalf of patients needing high cost medications.
• Conduct patient insurance, benefits and financial investigation and verification by directly communicating with patients.
• Complete initial and renewal prior authorization forms, negotiate authorization status with insurers, track status of medication approval, and when necessary, alert stakeholders of denials or nonresponse.
• Identify patient needs and ensure coverage of medication on their insurance plan through benefits investigation. If not covered, obtain necessary information from medical record, patient, and provider to enable justification for Patient Assistance program or copay assistance.
• Contact patients to provide information related to these resources.
• Facilitate enrollment of patients in patient assistance programs and collaborate with social services and case management on patient assistance.
• Assist pharmacists with preparing letters of medical necessity and coordinating peer-to-peer conferences.
• Expedite pharmacy workflow and enhance patient care by preventing therapy interruptions due to insurance issues in conjunction with pharmacists, physicians, transition care coordinators, nursing, and clinic staff.
• Communicate and collaborate regarding patient therapy interruptions, additional therapy monitoring requirements, and alternative care delivery setting options.
• Participate in revenue cycle committees to help identify causes of denied claims and develop workflow solutions to optimize revenue capture
• Facilitate staff training and competency, education and practice advancement
• Train new staff members
• Maintain a training and competency program for all staff that meets accreditation standards
• Coordinate with Pharmacy leadership to develop training experiences/competencies
• Represent the department at hospital meetings, committees, and events as requested
• Tele pharmacy Support: Answer incoming calls and respond to electronic communications • Assist health care providers and patients by greeting them by phone; answering questions and requests; referring inquiries to the site pharmacist(s) as needed. • Handle customer inquiries both telephonically and by email • Research required information using available resources • Manage and resolve customer complaints
• 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. Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Pharmacy Support Liaison – Patient Engagement Team

Revenue Cycle Specialist

• Entry level position responsible for submitting and resolving medical claims of low to moderate complexity.
• Must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements.
• Responds to requests from management, staff, or physicians in a timely and appropriate manner.
• Maintains patient and physician confidentiality and professionalism at all times.
• Follows department policies and procedures to ensure accurate and timely claim resolution.
• Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues.
• Attends and participates in team meetings.
• Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered.
• Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance.
• Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements.
• Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.
• Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment.
• Contacts patients and guarantors to secure necessary billing information.
• Documents accounts with clear and concise verbiage in accordance with departmental procedures.
• Reviews and responds to correspondence and inquiries received.
• Meets and exceeds team productivity and quality standards.
• Performs other related duties as assigned.

Revenue Cycle Specialist I

Assistant

• Collaborates and coordinates with all members of the health care team, patient and family (or significant others)
• Perform timely and accurate denial communications and activity; clarify communications as needed, and collect additional information in preparation for Nurse review
• Support the denial/appeal management nurse in collaborating with physicians, UM Nurses, PAS, and other members of the Interdisciplinary team, Revenue Cycle and payers to collect and relay all pertinent information to support successful appeals
• Document appeal activity according to department standards to support accurate reporting of denial and appeal status, outstanding revenue and to help identify trends
• Research and record appeals outcomes and produce reports related to denial and appeal outcomes

Appeals Assistant

Human Resources

• Provides advanced level Human Resources policy interpretation and guidance to managers and employees in a self-directed environment.
• Partner with business units and entity Human Resources leaders to develop effective strategies to proactively manage employee issues/situations and mitigate risk.
• Acts as primary interface between business unit leadership for all HR needs and partners with HR process leaders to align initiatives with business entity goals.
• Leads and implements change management initiatives in assigned business units. This includes but not limited to managing projects, programs, initiatives and making recommendations for organizational changes.
• Performs analysis on HR items such as turnover, retention, compensation, etc. and make recommendations for changes to management.
• Uses data analytics to evaluate, make recommendations and partners with operational leaders to influence change or drive improved results.
• Exhibit a level of ownership and initiative to influence and impact the business by mastering the Senior HR Business Partner competencies as outlined below.
• Performs other duties as assigned.

Senior HR Business Partner

Research Analyst

• To assist in ensuring compliant research billing practice for assigned department(s) at University Hospitals Health System, including knowledge & application of CMS regulations, maintaining UH billing standards, thorough knowledge and application of coverage analysis and budgeting principles, record maintenance and grant reporting. (60%)
• To manage and coordinate, under limited supervision, accurate grant accounting for assigned departments, and serve as a departmental resource to the grants team in overall management of research grants. (20%)
• To efficiently perform job duties, including documentation and maintenance of data, to meet management goals. (20%)
• Ensure compliant research billing practice for assigned department(s) at University Hospitals Cleveland Medical Center and UHHS, including comprehensive knowledge & application of CMS regulations, maintaining UH billing standards, and record maintenance including accurate grant reporting. (45%)
• Demonstrate efficient task performance, high level of organization and the maintenance of accurate administrative records, including database entries and reporting, to meet management goals. (15%)
• Through effective communication, provides guidance to colleagues and assists department research personnel in research patient billing matters. (10%)
• Develop patient care clinical project budgets which meet compliance and fiscal standards, utilizing thorough knowledge of coverage analysis and budgeting principles. Assist in negotiation of budget with Sponsor. (30%)
• Partner with revenue cycle to assist with resolving research claim denials, manage third party insurance issues, and independently process complex research claims according to CMS or private payor rules to ensure maximum payment recovery on outstanding billing. (30%)
• 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.

Research Finance Specialist I – II

• Answer incoming calls and respond to electronic communications.
• Assist health care providers and patients by greeting them by phone; answering questions and requests.
• Handle customer inquiries both telephonically and by email.
• Manage and resolve customer complaints.
• Process benefits investigations, prior authorizations, and copayment assistance request for prescriptions.
• Maintain current knowledge of pharmacy assistance programs.
• Evaluate all self-pay and underinsured patients for PAP/MAP eligibility.
• Work collaboratively with clinical based pharmacist to obtain clinical and financial information needed for program enrollment.
• Interact with physicians, nurses, and other health care professionals in a courteous and professional manner.
• Support all new team initiatives.
• Elevate issues promptly to supervisors.

Patient Support Advocate, Ambulatory Pharmacy

Counselor

• Provides excellent service and timely support.
• Performs assessment and collections activity on pre-service scheduled cases to resolve future and previous financial risk or escalate for appropriate review and approval in a timely manner (75%)
• Generate patient estimation of services as applicable and collect the specific deposit amount as outlined in UH policy
• Monitor, prioritize, collect and resolve self-pay accounts in accordance with standard operating procedures
• Assist patients with payment plan arrangements including collecting initial down payment as part of the process by following established departmental policy
• Monitor and work Financial Counselor worklist for respective locations and validates against the Encounter Prep Worklist to ensure all scheduled patients have been financially cleared
• Escalate financially risky accounts through designated escalation team for appropriate clinical and financial assessments
• Process payments by phone via electronic check, credit card, hard copy, payment database or any other approved means
• Informs patients and executes financial assistance opportunities (15%)
• Understand, explain, execute and help determine eligibility for hospital financial assistance programs
• Coordinates with agencies and other departmental vendors as appropriate to ensure eligibility for possible insurance coverage or government programs has been thoroughly reviewed and pursued
• Coordinates customer service support for patients inquiring about their account (10%)
• Identify patient or customer needs, clarify information, research and analyze issues, and provide solutions and/or appropriate alternatives
• Maintain patient and physician confidentiality and professionalism in accordance with departmental and HIPPA guidelines at all times

Financial Counselor

• Track, manage, and report finances and accounting related to clinical research services and tasks performed by team. (40%)
• Develop and monitor programs related to quality assurance and business projection (20%).
• Assists Manager in developing budgets for studies and research services. (20%)
• Track, manage, and report milestones and metrics related to research operations. (10%)
• Responsible for ensuring compliance with monthly, quarterly and annual reporting guidelines to internal and external regulatory agencies (including CRC, NIH, FDA, CTSC, etc.) (5%)
• Assists Manager in managing multiple committees and initatives to further grow and develop research services. (5%)
• Additional Responsibilities: Performs other duties as assigned. Complies with all policies and standards.

Clinical Research Business Operations Specialist, Peds Hematology/Oncology

Advocate

• Answer incoming calls and respond to electronic communications
• Assist health care providers and patients by greeting them by phone; answering questions and requests; referring inquiries to the site pharmacist(s) as needed.
• Handle customer inquiries both telephonically and by email
• Research required information using available resources
• Manage and resolve customer complaints
• Process benefits investigations, prior authorizations, pre-certifications, and copayment assistance request for prescriptions received by the UH Home Care Specialty Pharmacy.
• Maintain current knowledge of, requirements for and ability to enroll patients in: Pharmacy Assistance Program (PAP), manufacturer, state and local medication assistance programs; disease based assistance from non-profit organizations; Medicare prescription drug benefits; Social Security Low Income Subsidy; state and federal medication subsidy programs
• Maintain documentation of patient status for resource programs in required databases
• Evaluate all self-pay and underinsured patients for PAP/MAP eligibility and enroll patients based on financial need
• Work collaboratively with clinical based pharmacist to obtain clinical and financial information needed for program enrollment
• Utilize internally developed systems, commercial vendor software (to track patient eligibility, prescriptions, patient communications and program enrollment), outpatient clinical, scheduling and financial systems as necessary
• Interact with physicians, nurses, and other health care professionals in a courteous and professional manner
• Display the highest level of customer service, attentiveness, and consideration possible in all situations
• Support all new team initiatives
• Elevate issues promptly to supervisors to promote positive outcomes for internal and external customer
• Performs other duties as assigned.
• Complies with all policies and standards.

Patient Support Advocate, Medical Benefits

Learning and Development

• Become familiar with the areas of technology specialization in compliance with guidelines, policies and norms of UH.
• Meet with Subject Matter Experts to update content for online, self-paced and instructor-led learning modules.
• Design and develop engaging, interactive online and classroom training programs on products, process, systems and skills.
• Identify, develop and implement appropriate technology and instructional solutions for teaching and learning on multiple projects.
• Create all training objects, tools and supporting materials for curriculum and collaborate with training facilitators to teach the material through train-the-trainer and teach-back sessions.
• Create supporting material including exercises, activities, assessments, material and media (e.g. audio, video, simulations, role play, games, etc.) that enhances retention and learning transfer.
• Create and update learning resources and documentation including project documentation and course folders.
• Review feedback from internal clients and incorporate as needed.
• Assist Clients and technology staff to resolve issues related to technology used in teaching.
• Assist in troubleshooting developed courses in UH’s LMS (Cornerstone).
• Answer customer support questions and monitor helpdesk tickets for the applications you support and develop content for.

Instructional Designer

Clinical Research

• Manage Grant Accounts for Federal, State, Foundations, Industry Sponsors, and Internally Funded sponsors - including but not limited to creating grant awards; Manage invoicing, revenue generation, expenditure reports, Facility and Administration Costs, and grant close out.
• Responsible for grants reports for revenue and expenditures, invoice management, budget to actual analysis - for both UH internal and external customers
• Grants Invoicing, Grants to GL Account Reconciliation, Other tasks as assigned to meet the goals and mission of CCRT
• 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. Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients.

Grant Accountant I

Operations

• Responsible for supporting Radiology Operations, supporting radiologists, technologists, and/or other physicians requiring radiology assistance.
• Responsible for maintaining patient confidentiality while processing patient’s Radiology exams and reports including accurate and efficient image management.
• Contributes to the effective operation of University Hospitals and the Radiology Department.
• Provides support of the Radiology supported systems (examples: PACS, IDX, ect) including training, monitoring, and administration.
• Working Collaboratively with Physicians/Co-Workers/Patients in a professional and effective manner.
• Participating in on-call assignments.
• Performs other duties as assigned.
• Complies with all policies and standards.

Radiology Operations Specialist I

Credentialing Coordinator

• Analyzes and completes the initial and reappointment application approval process by utilizing independent critical thinking skills, which may involve extensive investigative review and interpretation.
• Partners with Medical Staff Leaders to develop policies, evaluation standards and privilege forms based on regulatory changes or hospital service changes serves as the liaison with Board Members, UH Senior Leaders and Administrators.
• Leads and manages provider performance evaluation process in accordance with Regulatory standards and Medical Staff Bylaws to assess clinical competency at initial approval and annually thereafter to monitor trends.
• Participates in all aspects of meeting management, to provide support for Credentials Committee, Medical Executive Committee/Clinical Council, Quality & Professional Affairs Committee, Hospital Board, and all other applicable medical staff meetings.
• Monitors and follows up on the proctoring process for privileges to ensure timely completion and documentation in accordance with credentialing requirements and regulatory standards for quality purposes.
• Manages the Medical Staff elections process, from ballot distribution through certification of results, ensuring adherence to bylaws and communication with Medical Staff leadership.
• Manages the Medical Staff Dues process, including preparing and distributing annual invoices, tracking payments, and maintaining accurate financial records in accordance with Medical Staff Bylaws.
• Collaborates with leadership to update and create new operational procedures as needed to align with industry standard.
• Serves as content expert and participates in onboarding and training of new team members and supports the medical staff with credentialing related projects as aligned with skill set.
• Investigates issues that arise with providers and may involve physicians, UH staff, and/or hospital leadership.
• Manages data quality and integrity for web-based applications based on defined standards through systematic audits.

Med Staff, Credentialing Coordinator

QA Engineer

• Coordinate activities within the Quality Assurance Program for the Clinical Research Unit. (20%)
• Perform extensive quality assurance review of study documents and data across multiple complex studies of different therapeutic areas and phases and report findings to management and research team. (30%)
• Assist the Quality Program Manager in regard to specific departmental activities with the goal of maximizing efficiency of management control systems, programs, policies, work methods and procedures. Establish and implement process improvement projects. (20%)
• Ensures that clinical trials are initiated, documented and reported in compliance with internal SOPs, GCP guidelines, sponsor guidelines and current applicable regulatory regulations. (20%)
• Create and maintain an education and training program for the Clinical Trial Unit. (10%)
• Performs other duties as assigned.
• Complies with all policies and standards.