Carle Health

• Provide comprehensive oversight of all activities related to health, pharmacy, and dental benefit programs, including plan performance, vendor management, compliance, and operational efficiency. • Partner with internal stakeholders and external vendors • Ensure benefit programs are administered accurately, efficiently, and in compliance with applicable regulations. • Facilitate timely resolution of benefit‑related issues • Oversee appeals processes to ensure fair, consistent, and prompt outcomes for team members. • Analyze trends in health, pharmacy, and dental utilization, costs, and outcomes • Identify opportunities for improvement. • Assess team member satisfaction with benefit programs. • Evaluate network adequacy, access to care, and cost efficiency across all benefit offerings. • Monitor pharmacy utilization and cost trends • Identify emerging issues and recommend appropriate plan or programmatic changes. • Research, assess, and recommend plan design enhancements based on utilization trends, market benchmarks, organizational priorities, and financial sustainability. • Collaborate with partners, vendors, and consultants to evaluate benefit design alternatives. • Develop actionable recommendations to support team member well‑being based on health and dental usage patterns. • Annual, or as needed, review of summary plan description • Prepare for and lead monthly and quarterly Health and Welfare Committee meetings, including agenda development, data presentations, recommendations, and follow‑up actions. • Partner with key stakeholders to align benefit strategies with organizational objectives. • Maintain strong vendor relationships • Ensure accountability, performance standards, and continuous improvement. • Assure plans are and remain compliant with all applicable laws. • Oversee the development and execution of all communication plans related to health, pharmacy, and dental benefits. • Ensure benefit communications are clear, accurate, timely, and supportive of informed decision‑making by team members. • Coordinate and lead the annual open enrollment process, including timelines, materials, vendor coordination, system readiness, and post‑enrollment follow‑up. • Develop and implement targeted actions, programs, or initiatives to support team member well‑being, informed by health and dental utilization trends. • Coordinate on‑site dental clinics and oversee development of related promotional and educational materials.

• Responsible for accurate and timely coding of hospital inpatient, outpatient and/or professional fee encounters using appropriate codes • Develop methodology to provide a coding process compliant with regulatory agencies • Serves as an expert resource for coding systems and regulatory guidelines • Performs provider and peer coding audits as requested

Role Description Responsible for auditing accounts prior to billing according to coding, regulatory, and payor policy guidelines. Addresses debit and credit charging errors to assure correct final bills. Audits documentation to make sure the chart documentation matches the charges on the patient account. Tracks and analyzes data trends, reporting those trends back to clinical directors and providing additional education to clinical staff where appropriate. Performs daily audits on all Inpatient and Observation accounts. Responsible for quarterly focused audits of areas with suspected or confirmed problems. Qualifications - Certifications: Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) - Education: Bachelor's Degree in Nursing Requirements - Performs daily audits of all Inpatient, Observation, ED and Outpatient Infusion via WQ monitoring, review of department revenue variance, and collaboration with operational areas. - For Observation accounts, auditor is responsible for analyzing number of hours charged and whether all are appropriate according to regulation. - Submits non-billable observation hours needing manual carve out to Revenue Integrity Charge Capture Specialist team for charge resolution. - For Observation accounts, auditor is responsible to add all IV infusion and injection charges according to the Centers for Medicare and Medicaid Services (CMS) guidelines. - Responsible for tracking and trending charge anomalies and reporting them back to the appropriate clinical department director. - Responsible for ad hoc training/retraining of clinical staff as needed. - If there is a charge, but no documentation, auditor is responsible to contact the department director or manager to validate charge appropriateness and ensure completion of documentation. - In partnership with Revenue Integrity leadership, plans, coordinates, and conducts audits/internal control evaluations and reviews as scheduled. Presents project results to leadership team. - Maintains knowledge of clinical documentation standards and charge related regulations and standards. Applies knowledge to ensure that charges are accurate and supportable according to payer and regulatory requirements. - Manages large complex projects, investigates and analyzes issues at a high level with strong attention to detail. - Completes and/or attends training and education sessions as assigned by leadership. Benefits - The compensation range for this position is $28.82 per hour - $49.57 per hour. - Carle Health offers a comprehensive benefits package for team members and providers.

Role Description This position provides nurse-triage support to nursing facilities and providers with a focus on operational efficiency and clinical quality. Supports clinical and operational best-practice for the nursing home practice and midlevel in home visits. Utilizes established guidelines for supporting nursing facilities and communicating with providers. Provides support to Carle Health Peoria providers related to prescription telephone calls and provides assistance, as needed. Demonstrates effective and timely communication skills, conflict resolution skills, decision making, and problem-solving skills. Qualifications - Certifications: - Education: - Work Experience: Requirements - Provides nurse-triage support to nursing facilities and providers with a focus on operational efficiency and clinical quality. - Asks questions according to the correct format specified in guidelines, resources, and standing orders. - Utilizes approved guidelines and protocols to provide advice to callers regarding health advice, directing them to the level of care necessary for the situation. - Provides support to Carle Health Peoria providers related to prescription telephone calls and provides assistance, as needed. - Answers questions from the general public regarding services of the organization utilizing information available in resources in the department. - Contacts physician on-call for unusual or complex situations for guidance, if the physician/provider is a participant in First Call program. - Contacts physician/provider on-call if caller verbalizes desire to speak to provider regarding prescription refill. - Ensures follow up of phone triaged calls. - Provides nurse triage support for providers in the nursing home practice. - Utilizes hospital approved abbreviations. - Uses First Call tools (policies, procedures, guidelines) effectively. - Utilizes remote access process effectively and efficiently (if applicable). - Demonstrates appropriate technical skills needed to utilize software and hardware used. - Maintains expert knowledge in the use of EPIC, Jabber, Infinity, and other applications used by First Call. - Utilizes EPIC and other on-line resources to access patient records and check for medical history, allergies and prescription information. - Completes documentation including pertinent assessment data, medications, allergies, and pertinent medical history, as appropriate. - Provides timely follow up information to providers in the nursing home practice and midlevel in home visits per established process. - Documents contact with other health care professionals such as pharmacists, physicians, advanced practice nurses, nurses, etc. - Documents inquiries to First Call in EPIC. - Completes accurate and timely data collection related to First Call process. - Performs other First Call functions and expectations. - Supports provider follow up billable services process with appropriate hand off of information and scheduling functions, as appropriate. - Ensures provider NH visits are scheduled based on guidelines available in the department. - Assists with referral management process as deemed appropriate by the First Call Lead or Manager. - Serves as resource for nursing facility staff to mentor facilities in appropriate use of nurse triage resources and supports the use and documentation of standing orders, if applicable, to partner facilities. - Supports midlevel in home visit scheduling and chart preparation processes. - Completes follow-up calls to patients as needed and other disease management/population health services for the organization. - Administers nursing home coverage, prescription refill, web scheduling, chat rooms, secondary referral, and call backs processes (as applicable). - Addresses issues promptly. - Identifies opportunities to improve First Call processes and performance. - Maintains working knowledge of existing hospital and physician practice policies and procedures. - Takes direction from team members and assists in various jobs on projects as assigned. - Demonstrates and promotes the standard processes. - Answers questions in a timely manner. - Demonstrates ability to help/assist with problems, ensuring positive outcomes. - Demonstrates willingness to help others, be patient, to share knowledge. - Listens intently to users and takes good ideas back for consideration to improve processes. - Organizes and completes assignments independently. - Delivers work on time. - Completes work accurately and well presented. - Is a valued contributor in team discussions. - Works with team to achieve effective conflict resolution. - Acquires expertise with appropriate direction from manager. - Conducts oral and written communications in courteous, respectful and pleasant manner. Benefits - The compensation range for this position is $30.39 per hour - $52.27 per hour. - Carle Health offers a comprehensive benefits package for team members and providers.

• Investigate and analyze actual and potential risks for Carle Health enterprise • Identify, analyze, and mitigate risks to patients, staff, and the organization • Develop and implement risk management policies and procedures • Conduct interviews in a non-biased, confidential and professional manner • Analyze investigation data and make recommendations

Role Description Revenue Cycle Systems Analyst Senior is a qualified/certified analyst in the module/systems assigned and is proficient in the Revenue Cycle Systems Analyst role. Develops, implements, modifies, tests and administers more complex modules and systems related to revenue cycle system applications. Acts on modifications where warranted. Develops complex application reports. Qualifications - Certifications: - Education: - Work Experience: Requirements - Performs essential job functions of Systems Analyst plus: - Coordinates with key user representatives to develop project task plans, timelines and schedules. - Designs simple and complex processes identifying deviations from functional requirements. - Develops system fallback. - Applies standards including regulatory requirements to system requirements and design. Makes recommendations that are in-line with and support best practice. - Performs application configurations. - Coordinates build and maintenance of various system parameter tables, issue enhancement logs, etc. - Acts as a resource and mentor to others. Benefits - The compensation range for this position is $35.22 per hour - $60.58 per hour. - Carle Health offers a comprehensive benefits package for team members and providers. Company Description Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. - Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. - We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. - We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. - Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. - We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health. - We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. - Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.

• Coordinating the provision of pharmaceutical care across all provider facilities, both inpatient and outpatient • Establishing the scope of services for pharmacy operations across the organization • Evaluating operations on an ongoing basis • Maintaining the highest quality and an appropriate scope to meet local and regional patient care needs • Acting as a key contributor in providing high quality, cost-effective pharmaceutical care across all Carle sites • Developing a strategic plan for pharmacy operations across the system • Developing and maintaining practice standards for all professional staff • Collaborating with nursing leadership • Developing and overseeing pharmacy purchasing strategy to maintain pharmacy supply chain across all Carle entities

Role Description The Patient Service Representative Supervisor coordinates staffing and activities of Patient Service Support staff for CBM, Carle Outpatient MRI and Carle BroMenn Outpatient Center. - Performs Essential Job Functions of direct reports. - Recommends and initiates various personnel actions including but not limited to hiring, performance appraisals, disciplinary actions, and promotions; makes work assignments and reviews and edits work of direct reports. - Ensures staff members are adequately trained and are competent to perform all required job tasks. - Resolves work-related issues or assists employees in solving work-related issues. - Resolves customer concerns, questions, and complaints by identifying problems and coordinating appropriate corrective action. Reports situation and resolution to supervisor. - Assists management in maintaining and developing a budget for supplies and equipment. - Supervises and assists staff with their job duties and responsibilities to ensure patient satisfaction and company profitability. - Acts as a patient advocate. - Demonstrates competency in all aspects of the Patient Services Representative role, including ordering clerical supplies, recall entry, multiple appointment scheduling, and managing a physician's schedule. - Serves as systems 'super user.' - Assists in training new Patient Services Representative staff and serves as a role model by conducting self in a responsible, professional manner. - Timekeeper in Kronos for all staff and stays within SVR targets; assists with the processing of payroll for direct reports by maintaining employee edit requests, PL requests, etc. - Handles scheduling and vacation approvals for all sites. - Meets and maintains all productivity targets and department goals that align with the strategic plan. - Works on Patient, Account, Claim Edit, and Router Workques Daily. - Responsible for design and implementation of policies related to the department including all other duties as assigned. Qualifications - Certifications: Certified Healthcare Access Associate (CHAA) within 2 years - National Association of Healthcare Access Management (NAHAM) - Education: H.S. Diploma/GED - Work Experience: Customer service Benefits - The compensation range for this position is $26.55 per hour - $44.34 per hour. - Carle Health offers a comprehensive benefits package for team members and providers. Company Description At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected, and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. - Nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. - Includes eight award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. - Developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. - Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. - Opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

• Manage accounts receivable in compliance with regulatory and billing guidelines • Collection of outstanding receivables through payer portals and phone lines • Responsible for accurate billing of insurance claims and following up on outstanding receivables • Work collaboratively with other departments to ensure claims are processed correctly

Role Description The HIM Certified Coder is responsible for accurate and timely coding of hospital inpatient, hospital outpatient and/or professional fee encounters using appropriate ICD10/ICDPCS, CPT, or HCPCs codes and appropriate coding software such as computer assisted coding and encoders as a means to ensure compliant billing of Carle claims. - Responsible for understanding and applying all regulatory coding guidelines, such as National and Local Coverage Determinations and application of CPT modifiers. - Responsible for understanding and applying coding knowledge to resolve billing edits related to coding. - Uses Carle electronic medical record systems to review clinical encounters. Qualifications - Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) - Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC) - Certified Inpatient Coder (CIC) - American Academy of Professional Coders (AAPC) - Certified Coding Specialist - Physician-Based (CCS-P) - American Health Information Management Association (AHIMA) - Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) - Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA) - Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) Requirements - Responsible for accurately coding all records according to the appropriate coding classification (ICD-10 and/or CPT and/or HCPCs and modifiers) system. - Provides interdepartmental coding assistance, as needed, to determine accurate coding assignment. - Develops methodology to provide a coding process that is compliant with regulatory agencies including the utilization of reference materials such as, but not limited to, Center for Medicare Services (CMS) publications, Coding Clinic, CPT Assistant, etc. - Facilitates optimization of revenue while maintaining compliance standards for the organization through varied venues and tasks (auditing/monitoring, training, facilitation of charges through the claim scrubber system, assisting with various patient or payor related charge/account inquiries, research on various coding/billing related topics as requested by various sources internal and external to the organization, etc.). - Serves as an expert resource regarding CPT, HCPCS, ICD-10-CM, all other necessary coding systems, and regulatory guidelines for all internal and external parties. - Serve as liaison for coding and billing staff to ensure accurate charge capture. - Reports any documentation and coding improvement needs based upon review findings. - Responsible for maintaining coding certification, knowledge and skills to successfully perform job duties. - Performs provider and peer coding audits as requested. - Assist with monitoring of internal controls for coding and billing. - Facilitates external audit activities and reporting of such activities to the appropriate administrative personnel. Benefits - The compensation range for this position is $23.58 per hour - $39.38 per hour. - The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. - Carle Health offers a comprehensive benefits package for team members and providers.