WVU Medicine

Onboarding Specialist

• Ensure candidates complete all pre-hire activities and are ready for new hire orientation
• Act as single point-of-contact from offer acceptance through first month of employment
• Contact candidates weekly to remind and monitor onboarding steps
• Monitor and adjudicate background checks and verify minimum job requirements
• Prepare new hire orientation lists for recruitment team
• Assist with new hire benefits enrollment; confirm dependent eligibility and approve life events
• Hire new employees into UltiPro, confirming all data fields prior to hire date
• Respond to escalated requests from candidates, managers, or recruiters and resolve per SLA
• Provide reports for candidate volumes
• Execute HR audit programs to support HR & Payroll compliance (I-9, eVerify, OFCCP, WV Cares, DHHR, Joint Commission)
• Complete necessary system transactions with appropriate reviews, approvals, and verifications

HR Onboarding Specialist

Customer Support

• Supervises and coordinates activities and employees related to all Enterprise Customer Service and processing including: billing, self-pay collections, customer service, and financial counseling of patients within West Virginia Medicine Hospitals, and University Medical labs to ensure the financial viability of the clinical and business enterprise
• Ensure the financial viability of the clinical and business enterprise
• Maintain appropriate internal control safeguards over accounts receivable records and collection of cash
• Establish and implement controls for submission, billing and payment cycles to ensure integrity of accounts receivable and patient information as well as supervising and controlling cash collected directly from patients
• Negotiate special discount arrangements, using sound financial practices, within the guidelines of State and Federal regulations
• Assures department compliance relating to the extension of credit, billing, and allowable follow-up
• Monitors daily operations to help ensure adherence to documented administrative and departmental policies and procedures
• Coordinates billing operations (including late charge issues, charge issues, coding issues) with other departments and/or outside referral sources/agencies/facilities to ensure continuity of care timely communication and accurate revenue cycle operations
• Identifies on-going continuing education needs of existing employees as well as new employees
• Complete annual reviews as well as 90 day review
• Keeps staff informed of process, policy and other changes through presentation at regular staff meetings, face to face communication and email correspondence
• Provides coaching and counseling to staff based upon performance management principals
• Efficiently and assertively coordinates resolution of problems with other departments as monitored by Manager or Director
• Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability, and efficiency
• Handles patient/family or staff complaints, investigates complaints, and makes recommendations of appropriate resolution
• Works with Manager or Director to develop and attain quarterly objectives
• Maintains confidentiality according to policy when interacting with patients, physicians, families, coworkers and the public regarding demographic/clinical/financial information
• Demonstrates flexibility to meet the needs of the department or hospital in regard to changes in work volume, planned change, scheduling changes, and emergency call – backs (i.e. weather or disaster)
• Maintains currently knowledge of major payor payment provisions
• Displays and understanding of third-party payor regulations related to managed care, denials, and reimbursement issues
• Able to inform patients of hospital and clinic billing practices/polices and their rights and responsibilities regarding payments

Customer Service Supervisor

Call Center Representative

• Schedules outpatients in accordance with scheduling guidelines, with the ability to prioritize according to patient needs.
• Answers phones from patients/customers professionally and responding to patient/customer inquiries and complaints.
• Schedules patients/customers based on scheduling guidelines and medical appropriateness.
• Researches required information using accessible resources.
• Routing inbound calls to appropriate resources.
• Obtaining and collecting all necessary information from the patient/customer to schedule the appointment.
• Manages communication and coordination between the patient/customer and the providers/clinics.
• Receives and responds to patient and staff needs and complaints appropriately within the realm of the 'patient care' environment, involving department supervisors and patient representative as needed.
• Participates in on-going educational activities to develop, maintain, and enhance professional expertise.
• Initial point of contact Centralized Schedulers in the Scheduling Call Center.
• If at any time, the Team Lead is unable to resolve an issue, they will confer with the Supervisor, Call Center and Manager, Patient Access.
• Works closely with Clinic Management, to ensure adequate communication between the Scheduling Call Center and the Clinic.
• Performs all duties of a Centralized Scheduler
• Must exceed expectations of a Registration Specialist and have an in-depth knowledge of the Call Center operations, scheduling, messaging and EPIC functions.
• Adheres to the established Performance Expectations for WVU Medicine Employees in the areas of People, Service, Performance Improvement, and Shared Values & Culture.
• Answer all questions regarding their Pod
• Oversee training for new employees for their pods
• Other duties may be assigned.

Call Center Team Lead

Support Engineer

• Provide financial and statistical analyses to support organizational leaders across the WVU Medicine System in decision making
• Compile financial and statistical data and create financial reports using techniques from various sources and systems
• Develop and run financial reports routinely on a daily, weekly, and monthly basis
• Provide ad-hoc financial analysis and proforma support to assigned hospital executive and department leadership for Acute and Critical Access Hospitals
• Prepare month end statistics for assigned Acute and Critical Access Hospitals for upload to GL System and answer resulting questions
• Prepare financial data and statistical reports for forecasting and provide scenario analysis based on assumptions
• Prepare statistical and gross revenue reports for budgeting and provide financial analysis for budgetary decisions
• Assist Hospital Leadership with evaluation of small capital or FTE investments by running base financials and creating projections
• Serve as the expert on stats and financials of assigned Acute and Critical Access Hospitals
• Provide quarterly signature line financial reporting and analysis
• Troubleshoot information systems issues within decision support platform to ensure data integrity
• Investigate systems such as Strata, Epic Slicer Dicer, and Tableau to find relationships between data and recommend optimizations
• Stay abreast of healthcare industry knowledge and internal systems
• Participate in department goals, teamwork, and performance improvement activities

Financial Decision Support Analyst

Insurance

• Obtain authorizations for elective procedures, referrals, tests, and surgeries; verify prior authorization requirements using payor resources and medical policies.
• Code cases and review clinical documentation to ensure documentation is complete and diagnosis/procedure/facility coding align with authorization obtained.
• Use EPIC work queues to obtain and follow up on authorizations; maintain in-baskets in Epic and emails in Outlook; provide timely authorization verification to avoid treatment delays.
• Schedule and follow up on peer-to-peer reviews and denials; submit and follow up on prior authorization appeals and obtain retro-authorizations as needed.
• Assist Patient Financial Services with denial management and escalate financial clearance risks in compliance with the Financial Clearance Program.
• Notify scheduling and physicians of any cases not authorized within department policy; maintain compliance with departmental quality standards and productivity measures.
• Work collaboratively and politely with physicians, schedulers, nurses, financial clearance/counselors, and other internal/external contacts; maintain confidentiality.
• Use hospital communications systems (fax, telephone, copiers, scanners, computers); perform prolonged periods of sitting and extended telephone work.

Insurance Authorization Specialist II

• Obtain prior authorizations for elective outpatient infusions and injections to ensure financial clearance and reimbursement
• Utilize payor resources, medical/coverage policies, and insurance portals to verify authorization requirements
• Serve as liaison between clinical teams and pharmacists regarding infusion prior authorization issues
• Code cases and review clinical documentation to maximize reimbursement
• Use EPIC work queues to manage workloads and communicate outpatient benefit information to Patient Financial Services
• Submit buy-and-bill authorizations, follow up on submitted requests, schedule peer-to-peers and submit appeals for denied medications
• Verify referrals and authorizations, identify medication dosing/frequency changes, and obtain retro authorizations as needed
• Maintain Epic baskets and Outlook emails, participate in team meetings, and follow established workflows
• Maintain confidentiality and professional, respectful communication with staff, physicians, patients, and families

Insurance Authorization Specialist III

• The position responsible for assuring all appointments and procedures are authorized.
• Insurance carriers are contacted to verify coverage and benefit limitations, tests and procedures are pre-authorized and scheduled, deductibles, co-payments, account balances, and fees are calculated and notations are added to the system for front end collection.
• Responsible for minimizing reimbursement errors resulting from inaccuracy of referral and enrollment information.
• Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
• Follows up on accounts as indicated by system flags.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
• Use work queues within the EPIC system for scheduling, transition of care, and billing edits.
• Performs medical necessity screening as required by third party payors.
• Documents referrals/authorization/certification numbers in the EPIC system.
• Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
• Communicates with the patient the anticipated self-pay portion co-payments/deductibles/co-insurance, and account balance refers self-pay, patients with limited or exhausted benefits to the in-house Financial Counselors to determine eligibility.
• Assists Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed.
• Communicates problems hindering workflow to management in a timely manner.
• Assesses all self-pay patients for potential public assistance through registration/billing systems Provides self-pay/under-insured patients with financial counseling information. Maintains current knowledge of major payor payment provisions.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• SKILLS AND ABILITIES: 1. Excellent oral and written communication skills. 2. Basic knowledge of medical terminology. 3. Basic knowledge of ICD-10 and CPT coding, third party payors, and business math. 4. General knowledge of time of service collection procedures. 5. Excellent customer service and telephone etiquette. 6. Minimum typing speed of 25 works per minute. 7. Must have reading and comprehension ability.

Insurance Specialist

Events

• Monitor healthcare associated infections
• Assesses infection prevention and control problems and makes recommendations for corrective action
• Participates in the Infection Prevention and Control Committee, if applicable.
• Oversees monitoring of infection prevention and control practices and personnel compliance for all departments
• Provides assistance to department managers in development of infection prevention and control departmental policies
• Reports communicable diseases to the local health departments and state as required by law.
• Provides educational presentations for orientation and ongoing in-services related to current recommendations and mandates.
• Consults with department leadership and physicians as needed to improve care delivery.
• Serves as a resource for all departments and personnel.
• Participates in short and long-range planning for the infection prevention and control department.
• Provides consultation to the Associate Health Nurse Practitioner related to exposure determination, personnel infections, follow-up and current healthcare personnel vaccination recommendations.
• Participates in performance improvement activities and committees.
• Conducts outbreak investigations and initiates control measures.
• May assist with development, implementation, and monitoring of the TB management program.
• Reviews and assists with environmental sampling as necessary.
• Participates and provides oral and written infection prevention recommendations for all construction, renovation, remediation, repair, or demolition as part of a multidisciplinary team during preplanning, demolition, construction and commissioning.
• Collects, prepares, and analyzes healthcare-associated infection data; presents data to leadership and stakeholders
• Provides internal and external reporting of information and data as required by law, accreditation requirements and regulatory mandates.
• Assists with development, implementation, and evaluation of plans for an influx of infectious diseases.
• Primary responsibility is surveillance (MUST understand NHSN definitions and federal/state/local regulations) 80% remote - 20% on site in Morgantown, WV

Centralized Surveillance Infection Preventionist

• The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an exhaustive list of all responsibilities and duties. Other duties may be assigned.
• Monitor’s healthcare associated infections
• Assesses infection prevention and control problems and makes recommendations for corrective action
• Participates in the Infection Prevention and Control Committee, if applicable.
• Oversees monitoring of infection prevention and control practices and personnel compliance for all departments
• Provides assistance to department managers in development of infection prevention and control departmental policies
• Reports communicable diseases to the local health departments and state as required by law.
• Provides educational presentations for orientation and ongoing in-services related to current recommendations and mandates.
• Consults with department leadership and physicians as needed to improve care delivery.
• Serves as a resource for all departments and personnel.
• Participates in short and long-range planning for the infection prevention and control department.
• Provides consultation to the Associate Health Nurse Practitioner related to exposure determination, personnel infections, follow-up and current healthcare personnel vaccination recommendations.
• Participates in performance improvement activities and committees.
• Conducts outbreak investigations and initiates control measures.
• May assist with development, implementation, and monitoring of the TB management program.
• Reviews and assists with environmental sampling as necessary.
• Participates and provides oral and written infection prevention recommendations for all construction, renovation, remediation, repair, or demolition as part of a multidisciplinary team during preplanning, demolition, construction and commissioning.
• Collects, prepares, and analyzes healthcare-associated infection data; presents data to leadership and stakeholders
• Provides internal and external reporting of information and data as required by law, accreditation requirements and regulatory mandates.
• Assists with development, implementation, and evaluation of plans for an influx of infectious diseases.
• Primary responsibility is surveillance (MUST understand NHSN definitions and federal/state/local regulations) 80% remote - 20% on site in Morgantown, WV

Infection Preventionist - Centralized Surveillance

• 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 to ensure collections and to exceed department goals.
• Gathers statistics, completes reports and performs other duties as scheduled or requested.
• Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency.
• Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up.
• 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.
• Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.
• Attends department meetings, teleconferences and webcasts as necessary.
• Researches and processes mail returns and claims rejected by the payer.
• Reconciles billing account transactions to ensure accurate account information according to established procedures.
• Processes billing and follow-up transactions in an accurate and timely manner.
• Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing.
• Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts.
• Maintains work queue volumes and productivity within established guidelines.
• Provides excellent customer service to patients, visitors and employees.
• Participates in performance improvement initiatives as requested.
• Works with supervisor and manager to develop and exceed annual goals.
• Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information.
• Communicates problems hindering workflow to management in a timely manner.

Insurance Claims Spec HB

Business Analyst

• Collaboratively interacts with Information Technology, Patient Access, Financial Services, HPN, and Decision Support.
• Remains current with how information is collected, maintained and reported in all key systems.
• Identifies data uses and develops analysis opportunities that are currently not used. Extracts and defines relevant information from the electronic health record related to client/patient, insurance or other revenue cycle/business operations data.
• Maintains technical knowledge and expertise in understanding patient access, clinician utilization, healthcare revenues, reimbursement and the correlation to the monthly financial statements.
• Completes complex financial/operational analysis from beginning to end with minimal supervision or direction from supervisor. Maintains and continually improves on technical skills needed to manipulate data.
• Supports the preparation of routine and ad hoc financial reporting focused on identifying underlying business trends, and work directly with local-level management to identify opportunities for improvement.
• Maintains intermediate reporting writing skills on StrataJazz, EPIC Reporting Workbench, BI, Epic Cubes and other systems as needed.
• Analyzes financial and operational data and develops financial models used to guide business decisions.
• Communicates and educates others regarding financial improvement analyses, denials issues, findings and recommendations.
• Provides leadership and support in performance improvement activities.
• Creates formal presentations of revenue cycle results and trends for senior management.
• Promotes and contributes positively to the teamwork of the department by assisting co-workers, contributing ideas and problem-solving with co-workers as observed by supervisor.
• Participates in performance improvement through planning and implementing change and maintaining and improving productivity through attendance and participation in staff meetings, committees, task forces, cross functional groups, projects and discussion with hospital and medical staff as observed by supervisor
• Monitors data against regional and national benchmarks as well as industry leading key performance indicators.
• Produces monthly revenue cycle dashboards and other performance metrics for senior leaders, local business owner and for front line staff.
• Validates workflows and source information as it is relevant to data.
• Collaborates with other business and financial analysts to streamline work, avoid duplication, and share best practices relative to data management.
• Produces reports and other analytics to quantify and define opportunities and issues.
• Interprets and summarizes results of various analyses in a timely and meaningful way.
• Re-engineers processes to positively impact productivity in terms of timeliness and accuracy.

Revenue Cycle Business Analyst

Insurance Claims Specialist

• 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 to ensure collections and to exceed department goals
• Gathers statistics, completes reports and performs other duties as scheduled or requested
• Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency
• Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up
• 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
• Accesses and utilizes all necessary computer software, applications and equipment to perform job role
• Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth
• Attends department meetings, teleconferences and webcasts as necessary
• Researches and processes mail returns and claims rejected by the payer
• Reconciles billing account transactions to ensure accurate account information according to established procedures
• Processes billing and follow-up transactions in an accurate and timely manner
• Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing
• Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts
• Maintains work queue volumes and productivity within established guidelines
• Provides excellent customer service to patients, visitors and employees
• Participates in performance improvement initiatives as requested
• Works with supervisor and manager to develop and exceed annual goals
• Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information
• Communicates problems hindering workflow to management in a timely manner
• Researches and resolves staff questions and concerns. Summarizes for supervisors/managers and works with leadership to resolve/improve workflows
• Works with HB Trainer to identify training opportunities for staff
• Works with Revenue Cycle Systems Coordinators to optimize Quadax and other PFS specific applications for end users
• Works with managers/supervisors and Contracting to prepare for payer meetings and calls by summarizing issues and collecting staff concerns
• Represents end users for vendor demonstrations, training sessions, payer workshops and educational sessions and communications information back to staff
• Exceeds productivity measures in like work group as demonstrated by Epic dashboards
• Leads special projects and/or other work assignments as assigned by Manager/Supervisor
• Assists supervisor with delegate staff work assignments

Lead Insurance Claims Specialist

Manager

• Manages all aspects of departmental grant application pre- and post-award process by developing strategies to meet and improve the organizations goals. Initiates the application process with the PI, drafts letter of intent to submit to the grant agency, prepares all data for the official agency application form(s), completes all internal application forms (includes assembling the final package being sent to the grant agency), and processes and creates a working budget for the application. Collaborate with the PI to collect, write, and edit all data and organize files according to the sponsor’s instructions in preparation for submission to the agency.
• Works with the PI through the entire submission process. Responsible for setting up a timeline from the onset to ensure that the application is submitted to all School of Medicine and Office of Sponsored Program approving agents well in advance of the submission due date to the agency. Responsible for making certain that the timeline created is adhered to by all parties to ensure the agency receives the application in time for consideration.
• Provides administrative and budgetary support for all faculty within the department. Monitors and maintains knowledge of all current agency funding opportunities and advises PI’s on searching for and selecting appropriate grant opportunities that fit their research interests. Supervises and completes all internal and external grant applications including, but not limited to: pre-award, competing and non-competing renewals, post-award financial and other reports and updates (ie progress reports, budget modification requests, no cost extensions, grant close out reports, etc).
• Develops the budget for all awards and ensures that the budgets are accurate and balanced prior to submission to the approving agents.
• Stays up to date on current granting laws, regulations, policies, and procedures to ensure that institutional and sponsoring agency policies are followed (ie NIH, DOD, AHA, NSF, USDA, etc). Maintains and uses this knowledge to serve as an advisor to the faculty by creating an effective application process which proves successful for submitting high quality applications.
• Verifies all salaries on grants are properly reflected and accounted for in accordance with the level specified in the grant award.
• Learns, interprets, and educates PI’s on the institutional and agency policies and procedures to ensure compliance is met when awards are granted. Assists the PI with grant closeouts through preparing final agency data reports.
• Assists PI with setting up training or completing necessary protocol application forms for projects requiring the use of animals, human subjects, or biohazards.
• Attends meetings, trainings, and seminars on behalf of the faculty to keep current of the vastly changing grant application process. Maintains current knowledge of the primary on-line granting tools such as ERA Commons, Proposal Central, Grants.gov, and internal systems such as the KC CAS system for grant routing. Provides training to PI’s as needed on how to utilize these tools for completing award updates or reports.
• Responsible for coordination of the annual departmental education conference for faculty and staff.
• Tracks and completes annual visual inventory of research related equipment for reporting and costing. Maintains these records.
• Tracks department grant applications, funded and non-funded applications, dollar amount of funding, and provides data to chair and administration as requested for annual reporting.
• Collects and maintains current faculty information and biographical sketches for collaborating purposes, and to update publication and official “other support” grant documents. Assists faculty with updating these forms to proper format, edits and makes sure comply with application guidelines.
• Tracks grant expenditures, creates reports, and works with the PI to make sure that all grant expenditures are properly tracked and accounted for within the award period. Submits Labor Distribution Adjustments for salary on grants in accordance with the award, submits salary lines for funded faculty and staff. This requires use of the Oracle (MAP) system for tracking salary and expenditures.
• Verifies effort reporting accurately reflects PI and faculty effort on grants. Provides detailed reports to PI and ensures all spending is within the spending guidelines of a particular award. Collects and maintains current faculty information and biographical sketches for collaborating purposes, and to update publication and official “other support” grant documents. Assists faculty with updating these forms to proper format, edits and makes sure comply with application guidelines.
• Tracks grant expenditures, creates reports, and works with the PI to make sure that all grant expenditures are properly tracked and accounted for within the award period.
• Submits Labor Distribution Adjustments for salary on grants in accordance with the award, submits salary lines for funded faculty and staff. This requires use of the Oracle (MAP) system for tracking salary and expenditures.
• Verifies all salaries on grants are properly reflected and accounted for in accordance with the level specified in the grant award.
• Verifies effort reporting accurately reflects PI and faculty effort on grants. Provides detailed reports to PI and ensures all spending is within the spending guidelines of a particular award.
• Tracks RVU for all faculty member and provides reports on goals, current levels, and requirements for eligibility for incentives. Coordinates FARA elections and tracks completion of goals toward incentives
• Responsible for annual reports of activity on gifts to the department in the form of Foundation gifts to specific groups for research and outreach.
• Responsible for WVUH and UHA payroll submission via KRONOS system for all department employees. Acts as back-up for State payroll and leave system. Attends training to keep current in this knowledge as it is offered or needed.
• Responsible for Departmental invoicing of all reimbursable expenses between entities for WVU, UHA, WVURC via the Lawson and Oracle (MAP) systems. Completes monthly invoicing for all reimbursement to the department and follows up on aging to ensure timely collection of revenues.
• Prepares sub-contract agreements for the lease of time of employees to the grant.
• Assists the Department Chairman when needed. Provides data, reporting, information, and updates on all grant related projects. Keeps the Chairman informed of upcoming deadlines, issues, reports, awards, and requirements.
• Responsible for Role-based requests for the department to provide all employees of the department with access to systems appropriate for their position and job title.