WVU Medicine

Auditor

• Responsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers.
• Will also oversee or perform the overall auditing and education plans for the Coding staff.
• Responsible for the overall auditing and education plans for the Coding staff.
• This position will perform coding quality audits, provide ongoing feedback and education.

Coding Auditor-Educator

Call Center Representative

• Responsible for scheduling, cancelling, rescheduling, and registering outpatient visits and procedures for multiple ambulatory clinics
• Obtain and verify patient guarantor information at least once a year
• Schedules and registers patients/customers based on scheduling guidelines
• Obtains and collects all necessary information from the patient/customer
• Identifies and communicates need for scheduling modifications
• Notifies appropriate personnel of any scheduling change in a timely fashion
• Receives and responds to patient and staff needs and complaints
• Consults with referring physician’s office to ensure written and/or electronic orders exist
• Completes Workques in a timely fashion along with daily tasks

Scheduler – Call Center

Director

• Leads the activities of the clinical nutrition department including the nutritional care of patients.
• Responsible for planning, organizing, developing, and directing nutrition guidelines, initiatives, and operations for Clinical Nutrition
• Promotes nutritional education for diabetic patients through ongoing provider education
• Collaborates with individuals in both the inpatient and outpatient areas to coordinate care of patients across the health care continuum.

Director of Clinical Nutrition

Supply Chain

• Ensures all materials are received, stored, and distributed properly
• Inputting and retrieving data in the materials management module
• Assists and communicates with Buyers and/or Supply Chain leadership
• Maintain understanding of supply automation systems
• Handles supply requisitions and delivers supplies throughout the hospital
• Assists hospital employees with ordering supplies
• Conducts physical inventories and cycle counts
• Operates material handling equipment safely

Supply Chain Technician

Manager

• Directs the staff and operations of the coding department.
• Holds staff accountable for achieving plans and performance targets.
• Develops a high-performing team that provides superior project management skills.
• Maintains strong understanding of coding metrics, leadership skills, project management, and leads the team in building plans to support operational departments.
• Ensures compliance with government and commercial coding regulations and standards.
• Leads the coding departments strategic plan objectives and operational goal setting and execution.
• Continuously evaluates the effectiveness and efficiency of operations and implements or proposes optimization or transformation efforts.
• Develops and maintains strong relationships with clients/providers.
• Provides regular revenue management reports to clients, providers, and management.
• Manages operational expenses in accordance with the budget.
• Works collaboratively with coding department leadership to meet strategic goals and develop guidelines and procedures.

Manager, Enterprise Coding

• Responsible for strategic leadership, growth, and program development for surgical and non-surgical specialties.
• Collaborates with physicians and clinical leadership to execute effective initiatives, plans and tactics.
• Develops, implements, and monitors clinical program goals for inpatient and ambulatory settings.
• Provides leadership and strategic vision to operationalize standard processes relating to clinical programs.
• Collaborates with leadership to develop departmental/clinic budgets and reviews budgetary compliance.

Director, Women's & Children's Services

Pharmacist

• Perform drug utilization review for initial determinations and/or appeals for ASO clients and Medicare Advantage plan.
• Collaborate as an integral member of the pharmacy team.
• Serve as subject matter expert for pharmacy utilization management.
• Ensure timely execution of all drug reviews in compliance with accreditation and regulatory standards.
• Work with Medical Director and Clinical Formulary team to review specialty medications requiring a consult.

Clinical Utilization Management Pharmacist

Insurance

• This position is responsible for obtaining authorizations for elective infusions and injections to financially clear patients and ensure reimbursement for the organization.
• Payor resources and any other applicable reference material such as payor and medical policies should be utilized to verify accurate prior authorization requirements.
• Escalates financial clearance risks as appropriate in compliance with the Financial Clearance Program.
• Serving as a liaison between clinical teams and pharmacists ensuring effective communication regarding infusion prior authorization issues.
• Cases are to be coded, and clinical documentation reviewed to ensure the documentation is complete to maximize reimbursement.

Insurance Authorization Specialist III

Community Manager

• Support the operational efficiency of the Pharmacy Department by coordinating fiscal management activities.
• Perform data analysis and maintain departmental statistics and reports.
• Work with clinical pharmacists, residents, medical staff, and pharmacy administration.
• Assure that billing procedures performed by the department are accurate and timely.
• Coordinate with Patient Financial Services to review underpayments or denials.
• Review medications administered that are included on the transitional pass-through list and assure accurate billing procedures are followed.
• Assures charges governed by APC’s are handled correctly.
• Facilitate the addition, deletion or correction of charges to the charge master as needed.
• Maintain all the HCPCS changes and updates for Chargemaster.
• Assure utilization of all available indigent care programs for inpatient and outpatient Administration of medications.

Pharmacy Analyst – Community Pharmacy

• Responsible for securing patient data based upon comprehensive data elements.
• Financial education/counseling.
• Insurance verification.
• Provision of clinical information for pre-certification, authorization and third party claims management.
• Interviews patient for clinical, financial, and history information and arranges appropriate clinical care.
• Work independently gathering and submitted patient information with oversight of a pharmacist as needed.
• Perform pharmacy related functions in compliance with departmental policies and procedures that provide optimal pharmaceutical care.
• Drafts various correspondence letters and sends to referral source when necessary.
• Gathers and documents patient demographics, insurance information, needs assessment, patient history, and other data as needed.
• Initiates refill/follow up calls and schedules delivery as needed.
• Provides information and answers to patient/caregiver questions and refers to clinician when appropriate or requested.
• Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Maintains patient records in a timely and complete manner.
• Assists the pharmacist with the process of filling and labeling the prescriptions.
• Calculates initial measurements for compounds and maintains compounds logs.
• Provides monographs and other required medication guides with each prescription.
• Maintains proper storage of medications (i.e. security, temperature controlled items, etc.).

Clinical Pharmacy Tech II – Community Pharmacy

• Submits accurate and timely claims to third party payers.
• Resolves claim edits and account errors prior to claim submission.
• Adheres to appropriate procedures and timelines for follow-up with third party payers.
• Gathers statistics, completes reports and performs other duties as scheduled or requested.
• Organizes and executes daily tasks to achieve optimal productivity, accountability, and efficiency.
• Contacts third party payers to resolve unpaid claims.
• Utilizes payer portals and payer websites to verify claim status and conduct account follow-up.
• Assists Patient Access and Care Management with denials investigation and resolution.
• Researches and processes mail returns and claims rejected by the payer.
• Reconciles billing account transactions to ensure accurate account information.
• Maintains work queue volumes and productivity within established guidelines.
• Communicates problems hindering workflow to management in a timely manner.

Insurance Claim Specialist

Therapist

• Provides evaluation of and care for respiratory therapy patients • Administers prescribed respiratory therapeutic services • Performs basic and advanced therapeutic procedures for patients • Initiates, maintains, and discontinues mechanical ventilation • Communicates effectively with healthcare team • Participates in departmental quality assurance and performance improvement activities

Respiratory Therapist – Casual

Systems Engineer

• Supports the design, implementation, and maintenance of software systems.
• Assists in system troubleshooting and providing end-user training.
• Works closely with senior team members to ensure system functionality and deliver user support.
• Aids in testing activities and system performance optimization.
• Assists with user security management under guidance of senior analysts.
• Collaborates with team members for system enhancements based on organizational needs.
• Assists in managing data transfers and generating reports for accurate data handling.

Associate Systems Analyst – Software Trainer, Inpatient and Outpatient Provider Training

Claims Specialist

• Managing patient account balances including accurate claim submission
• Compliance with all federal/state and third party billing regulations
• Timely follow-up and assistance with denial management
• Submits accurate and timely claims to third party payers
• Resolves claim edits and account errors prior to claim submission
• Contacts third party payers to resolve unpaid claims
• Utilizes payer portals to verify claim status and conduct follow-up
• Participates in educational programs to meet mandatory requirements

Insurance Claims Specialist

• Provides evaluation of and care for respiratory therapy patients
• Administers prescribed respiratory therapeutic services
• Initiates, maintains, and discontinues mechanical ventilation for adult, pediatric, and neonatal patients