WVU Medicine

Medical Billing and Coding

• Codes inpatient and/or IRAD 90% of current FTE status.
• Reviews and accurately interprets medical record documentation from all hospital accounts in order to identify all diagnosis and procedures that affect the current inpatient stay or outpatient encounter and assigns the appropriate ICD-10-CM, ICD-10-PCS, CPT, or modifier codes for each diagnosis and procedure that is identified (inpatient and IRAD).
• Ensures appropriate MS-DRG assignment based on accurate ICD-10-CM and ICD-10-PCS coding assignment and medical record documentation.
• Assigns hospital codes to a variety of patient classes (i.e. I/P, IRAD, etc.).
• Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas.
• Maintains and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in-services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals.
• Assures the accuracy, quality, and timely review of data needed to obtain a clean bill.
• Contacts physicians or any persons necessary to obtain information required for to accurately code assignments. Works and communicates with other offices in any manner necessary to facilitate the billing process.

Inpatient Hospital Coding Specialist, Level III

Community Health Worker

• Conducts in-home, clinic-based, telephonic, and community-based wellness visits with patients/members as assigned.
• Completes health risk assessments, social needs screenings, and follow-up activities to identify barriers related to health care access, food, housing, transportation, medication access, safety, utilities, and other social drivers of health.
• Provides support, education, and reinforcement to help patients/members understand and follow their individualized care plans.
• Supports medication adherence by providing reminders, identifying barriers to medication access or understanding, and escalating concerns to the appropriate clinical team member.
• Assists patients/members with appointment reminders, follow-up care needs, preventive screenings, immunizations, routine checkups, and appropriate use of their medical home.
• Facilitates transitions of care after hospital, emergency department, or skilled nursing facility discharge by assisting with outreach, follow-up needs, appointment coordination, resource connection, and escalation of concerns.
• Connects patients/members to appropriate internal and external resources.
• Helps patients/members access community-based resources, including food assistance, housing support, transportation resources, utility assistance, financial assistance programs, and other social service supports.
• Assists patients/members with completion of forms, applications, resource referrals, and follow-up steps needed to access programs or benefits for which they may be eligible.
• Serves as a trusted liaison between patients/members, families, community organizations, health care providers, clinics, and social service agencies.
• Builds positive, supportive relationships with patients/members while promoting engagement, self-management, and active participation in health and wellness goals.
• Documents all encounters, outreach attempts, assessments, identified needs, interventions, referrals, and follow-up activities in the appropriate electronic system according to departmental expectations.
• Escalates concerns related to safety, unmet social needs, changes in health status, behavioral health concerns, medication concerns, suspected abuse/neglect, or barriers requiring clinical or social work intervention to the appropriate team member.
• Maintains current knowledge of community resources, health care services, payer resources, internal programs, and referral pathways.
• Works collaboratively and effectively within a team while also demonstrating the ability to work independently in community-based settings.

Manager

• Directs the staff and operations of the coding department
• Ensures optimal performance through effective employee selection, training and development and performance management
• Holds staff accountable for achieving plans and performance targets
• Works with staff to identify and resolve the most complex issues and problems impacting the department
• Supports development and continued professional growth to meet company and individual goals for long-term success
• Develops a high-performing team that provides superior project management skills and supports the overall coding department to drive and improved financial performance in accordance with state and federal guidelines and standards
• Maintains strong understanding of coding metrics, leadership skills, project management, and leads the team in building plans to support operational departments to achieve optimal practice performance through strong analytical capabilities, process improvement identification, and technology enhancements
• Ensures compliance with government and commercial coding regulations and standards while maximizing reimbursement for patient claims
• Works with company compliance and legal staff to maintain appropriate procedures and to represent the company in litigated matters
• Advises management of actions and potential risks
• Leads the coding departments strategic plan objectives and operational goal setting and execution through departmental leadership
• Design, implement, and ongoing monitoring of all relevant key performance indicators to ensure that cash flow is maximized throughout the revenue cycle
• Continuously evaluates the effectiveness and efficiency of operations and implements or proposes optimization or transformation efforts
• Continually identifies opportunities for enhancement and optimization of the overall coding process of the organization
• Reviews current best practices for coding department and other functions and makes improvements as needed
• Develops and maintains strong relationships with clients / providers
• Effectively manages relationships and business processes at all clinics / physician offices and hospitals
• Establishes and maintains strong working relationships with Revenue Cycle leaders and fosters a strong working relationship with Information Services
• Develops, implements and effectively manages policies, processes and procedures for the coding department that result in maintaining coding charge lag, productivity, and coding quality at or above goal levels
• Provides education and policy updates for clinic, hospital and division employees, medical staff on policy or procedures
• Establishes and conducts performance reporting for revenue / coding activities of each location
• Works collaboratively with local CFO's, physicians, department heads, and practice manager(s) to develop and maintain a culture of high performance and accountability across organizational boundaries
• Provides regular revenue management reports to clients, providers, and management
• Alerts senior management of concerns and provides status of financial conditions of the company by collecting, interpreting and reporting key financial data
• Communicates coding changes and CPT updates
• Manages operational expenses in accordance with the budget
• Directs and oversees the development of operating and capital budget for the department
• Works with IT to implement system-wide programs and information systems to create and maintain functional capabilities that equal the best in the industry
• Provides ongoing leadership and operational oversight in the development, use and maintenance of the clinics and hospital information systems for coding
• Provides coding oversight for system implementations, conversions, and upgrades for revenue cycle applications
• Address any operating issues that are hindering the maximization of cash flow, which may result in adopting new best practices
• Works collaboratively with coding department leadership to meet strategic goals and develop guidelines and procedures through use of data analysis
• Arranges for billing/coding audits as required and appropriate with contracted compliance company
• Continually ensures high ethical standards, and promotes and leads coding transparency, and a commitment to client service excellence.

Manager – Profee Surgical Specialties, Anesthesia Coding Teams

Clinical Educator

• Design and lead systemwide CDI, coding, UR, and denial management training using data-driven curriculum, competency assessments, and audit outcomes to improve accuracy, compliance, and preventable denials.
• Provide focused training on DRG/CPT updates, clinical criteria, and payer policies; support onboarding of new providers and hospitals with standardized documentation and utilization expectations.
• Offer individualized, case-based support to staff and providers, addressing real-time documentation, coding, medical necessity, and appeals questions.
• Develop concise tip sheets, payer grids, documentation guides, and workflow references that reflect current CMS and payer standards.
• Equip providers with clear guidance on admission criteria, medical necessity documentation, peer-to-peer expectations, and high-risk payer issues.
• Monitor query accuracy, status determinations, DRG shifts, downgrades, and overturned denials; ensure findings drive corrective education.
• Review internal/external audits to identify documentation, coding, or utilization gaps; deliver targeted education based on root causes.
• Develop a coordinated, enterprise-wide education roadmap aligned with regulatory updates, audit trends, and CRC strategic priorities.
• Collaborate with UR/CDI/Denials/RI leaders to interpret payer rules and create targeted training that reduces preventable denials.
• Use insights from ClinIntell, CloudMed, Solventum, and Epic reports to focus education on high-impact conditions, DRGs, and denial patterns.
• Gather frontline feedback, translate operational challenges into education updates, and ensure consistent cross-facility communication.
• Develop cross-functional education modules that reinforce LOS optimization, DRG integrity, denial prevention, and Epic workflow standardization.
• Provide expert guidance to directors, physicians, and executives on documentation integrity, medical necessity, and denial mitigation.
• Track completion, competency, audit scores, and denial trends to evaluate program impact and refine future education priorities.
• Deliver concise, data-driven summaries of progress, gaps, and recommendations to CRC leadership and CFO councils.

Clinical Revenue Cycle Educator

Scheduler

• Responsible for scheduling, cancelling, rescheduling and registering of outpatient visits and procedures for multiple ambulatory clinics.
• Collecting all necessary information for schedule and registration preparation.
• Obtain and verify patient guarantor information a minimum of once a year to ensure that the patient record is up-to-date.
• Schedule and register patients/customers based on scheduling guidelines and medical appropriateness within the appropriate clinic.
• Obtain and collect all necessary information from the patient/customer to schedule and register the patient for an appointment.
• Identify and communicate need for scheduling modifications and development.
• Notify appropriate personnel of any scheduling change due to patient cancellation in a timely fashion.
• Receive and respond to patient and staff needs and complaints appropriately within the realm of the “patient care” environment, involving department supervisors and patient representatives as needed.
• Consult with referring physician’s office to ensure written and/or electronic orders exist and obtain them as needed.
• Verify upon receiving for completeness of the written orders and notes.
• Make documentation that outside orders are requested.
• Complete Workques as needed in a timely fashion along with daily tasks according to the scheduling area working in.
• Respond to all patient communication in a timely manner.
• Escalate any immediate needs to the appropriate area of responsibility.

Centralized Scheduler

• Analyze and resolve issues of missing charges and problem accounts.
• Ensure appropriate reimbursement, compliance, and charging with the various coding guidelines and regulatory agencies.
• Code a variety of patient classes including inpatient, observations, same day care, etc.
• Perform the coding/billing Split Claims process.
• Maintain and enhance current levels of coding knowledge through various means.

Coding Specialist II

Analyst

• Supports the WVUHS Medical Group ambulatory network through the collection, analysis, and reporting of quality, safety, access, patient experience, and performance data to drive continuous improvement
• Partners with clinical, operational, and administrative leaders to advance quality outcomes, regulatory compliance, patient experience initiatives, and performance improvement efforts
• Translates complex data into actionable insights that support evidence-based decision-making and align with WVU Medicine’s mission to improve community health outcomes
• Collect, validate, and analyze quality, access, patient experience, and safety data
• Develop and maintain standardized dashboards, scorecards, and reports aligned with WVU Medicine priorities, payer requirements, and regulatory benchmarks
• Develop and utilize tools to track, analyze, and report quality metrics
• Monitor trends, identify gaps in performance, and escalate risks or opportunities for improvement
• Support practice-level and systemwide quality improvement initiatives using established improvement methodologies
• Assist with root cause analyses, action plan development, and outcome tracking
• Partner with practice leaders and operational teams to promote standardized workflows and sustain improvements
• Support SMG compliance with ambulatory regulatory, accreditation, and payer quality requirements
• Assist with audit preparation, survey readiness, measure abstraction, and submission of required data
• Maintain accurate documentation and reporting to support ambulatory accreditation and quality programs
• Prepare presentations and summaries for leadership, committees, and practice teams
• Effectively communicate quality performance insights to clinical and operational stakeholders
• Support ambulatory quality councils, workgroups, and system initiatives as assigned

Quality & Performance Improvement Analyst – Ambulatory

Supervisor

• Supervises coding staff and assists the management team in the day-to-day operations of the department, as it pertains to reimbursement, coding, abstracting, productivity, quality and education.
• Ensures that all coding backlogs, work queues and charge lag remains at acceptable levels.
• Acts as expert coding resource not only to coders, providers and revenue cycle, but also to specialty groups and meetings.
• Responsible for personnel management of coding staff, including but not limited to, interviewing, hiring, coaching and counseling, discipline and performance evaluation in conjunction with management.
• Develops and maintains coding related policies, procedures, and training materials in conjunction with management.
• Identifies budgetary needs and maintains fiscal stewardship.
• Conducts and/or oversees internal and external auditing to determine compliance with medical record documentation, coding and billing guidelines.
• Works with staff to analyze and resolve issues that impact coding and billing.
• Maintains effective, open and ongoing communication.
• Extracts, analyzes and reports data to appropriate management team.
• Serves as a liaison to vendors and provides input and tests information systems.
• Assists in staff coding, as needed.

Supervisor, Enterprise Coding

Technician

• Understands and practices the principles of aseptic technique.
• Evaluates equipment needs of patients being transferred from critical care units to the OR and OR to Phase I Recovery.
• Ensures basic anesthesia equipment is available in each anesthetic location including emergency airway equipment.
• Assists with line placement by aiding inserter.
• Cleans up a hazardous spill ensuring SDS sheets are followed.
• Sets up disposable supplies and assists with all therapeutic pain management applications.
• Provides Anesthesia support during all emergency situations and routine case turnover.
• Monitors the inventory of consumable supplies.
• Informs appropriate persons of equipment issues and potential problems.
• Sets up IVs, fluid warmers, and pressure transducers.

Anesthesiology Technician

General

• Responsible for posting insurance and/or patient payments to Epic and balancing those postings to the bank deposits in a timely and accurate manner
• Assists Departmental Coordinator in researching and resolving outstanding deposits and unidentified or missing payments
• Processes electronic remittances initiating transaction posting in Epic
• Works transactions that do not post correctly to ensure that transactions route to the appropriate accounts
• Identifies any unidentified payment transactions that route to the clearing account, following facility processes to move non-patient money to correct general ledger account
• Balances postings to bank deposits utilizing provided technical tools in Epic and via Microsoft Excel
• Maintains timely and accurate posting according to departmental goals and report to management
• Documents accounts clearly and accurately
• Analyzes and reconciles posting amounts from patient payment and other sources of payment (non-accounts receivable (AR) cash) to the patient accounting system and accounting department
• Uses system software, including online credit card systems and the Epic system
• Creates, enters, and assigns cash management batches
• Opens and distributes mail received from the post office and financial institutions for the various entities services are billed for
• Contacts the appropriate third party payors, business entities, or financial institutions to resolve unidentified or missing payments
• Accesses any scanned information via One Content imaging system
• Completes and reconciles bank deposits daily
• Utilizes remittance work queues to resolve payment errors
• Reviews and reconciles all postings monthly with the Departmental Coordinator as needed
• Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth
• Researches accounts in work queues with credit or undistributed self-pay balances, and works to resolve these balances by distributing to other outstanding account, refunding another approved facility, or refunding the guarantor
• Investigates insurance overpayments and takes appropriate action from within the work queue to resolve the variance
• Processes refund requests received from third party payors, clinical departments, other areas of Revenue Cycle, and leadership
• Monitors accounts that fall within out special billing guidelines (i.e. cosmetic, bariatric, IVF, plastics, etc.) to insure pre-payment application is done within a timely manner
• Works with the appropriate accountants to maintain a list of all unclaimed property, and maintain a spreadsheet for submission to the state
• Takes calls from registration and customer service staff experiencing issues with cash drawers, and works to resolve the issues
• Insures all refund requests are received from accounts payable, and processes the checks for submission to third party or guarantor
• Maintains current knowledge of payor payment provisions and all local, state, and federal collection laws
• Contacts insurance company or employer to determine eligibility, benefits, and payment information necessary to refund or distribute payments
• Ability to accurately utilize payor portals to initiate overpayment recoveries
• Identifies missing charges and communicates with appropriate coding manager for re-entry
• Completes reports assigned by Revenue Cycle leadership for bulk refunds to third party payors
• Monitors work queue for inappropriate hospital payments posted to professional billing, and works with appropriate entity for posting
• Assists hospital cashier’s office in locating and resolving missing receipts
• Aids accounting department in reconciling patient payments for the entity in which the receipt was deposited

Payment Application Specialist

• Provides intraoperative care to patients by functioning as the scrub person assisting the surgical team during operative procedures
• Serves as a scrub mentor to others performing the scrub role on service cases
• Assists RN Service Line Coordinator to standardize instrumentation
• Contributes input into the updating of preference cards used within the service line
• Assists with the care and monitoring of service equipment and supplies
• Utilizes quality aseptic technique when working in an unsterile or sterile role in the OR
• Assists the circulating RN in monitoring technique of all persons in the OR to maintain a sterile field
• Performs sponge, instrument, and needle counts with the circulating RN following established guidelines
• Assists with gowning and gloving surgeons and positioning equipment and instruments
• Passes sterile instruments to the surgical team during a surgical procedure
• Assists with transportation and positioning of the patients to include assisting the surgical team by holding retractors and position of operative limb under direction of surgeon
• Prepares supplies and equipment for surgical procedure following preference cards
• Assists with sterilization and maintenance of sterile and non-sterile supplies and equipment
• Monitors inventory; orders; and restocks supplies, instruments, and equipment
• Removes out-of-date items and discards or reprocesses following established guidelines
• Assists with the general cleaning duties of the department
• Performs equipment checks as assigned
• Assists with the proper recording of patient charges
• Call with a response time of 30 minutes
• Serves as a mentor to the team and supports the development of level one, two, & three technologists
• Participates in unit-based education activities and may participate in presenting in-services for the staff

Surgical Technologist

• Serves as a trusted community-based liaison, navigator, and member support resource
• Supports patients and members by conducting in-home and community-based wellness visits
• Completes health risk assessments and follow-ups
• Identifies barriers to care and connects individuals to resources
• Reinforces care plan goals
• Works closely with interdisciplinary care team
• Helps navigate the health care system and improve engagement in preventive and chronic disease care
• Supports medication adherence and transitions of care after discharge
• Conducts wellness visits and social needs screenings
• Documents all encounters and escalates concerns appropriately
• Maintains knowledge of community resources and connects patients to them
• Works collaboratively and independently in the community.

Assistant

• Perform anatomic pathology services under the direction and supervision of a licensed, board-eligible pathologist.
• Perform a variety of pathology tasks including gross examination and dissection of surgical pathology specimens and performance of postmortem examinations.
• Preparation, gross description, and dissection of human tissue surgical specimens.
• Preparation of human postmortem examinations.
• Specimen accessioning.
• Describe gross features of surgical specimens.
• Obtain samples for studies such as but not limited to flow cytometry, image analysis, research, cytogenetics, cultures, electron microscopy, immunofluorescence.
• Consult with attending pathologist to identify special techniques to be utilized during the examination, including cultures, toxicology, coronary artery perfusion, enucleation, etc.

Pathologists' Assistant

Member Service Representative

• Verify member information while addressing general questions.
• Responds to and resolves all issues/inquires to assure an efficient and seamless member experience.
• Maintains open channels of member communications doing outreach as required.
• Meets all production and quality standards, maintaining work queues according to department standards.
• Effectively communicates with internal and external staff.
• Elevates issues to the next level of supervision, as appropriate.

Emergency Medicine

• The successful candidate will practice in the areas of Emergency Medicine.
• Providing comprehensive outpatient clinical care to patients in an emergency medicine capacity.
• Establishing preventive health practices for patients.

Inpatient Hospital Coding Specialist, Level III

Community Health Worker

Manager – Profee Surgical Specialties, Anesthesia Coding Teams

Clinical Revenue Cycle Educator

Centralized Scheduler

Coding Specialist II

Quality & Performance Improvement Analyst – Ambulatory

Supervisor, Enterprise Coding

Anesthesiology Technician

Payment Application Specialist

Surgical Technologist

Community Health Worker

Pathologists' Assistant

Member Service Representative

PRN APP, Emergency Medicine