Corewell Health

Role Description Provides support for the EDI Operations department by interfacing with internal and external customers including business analysts, software developers, project managers, trading partners, and software vendors. This role is responsible for managing a range of EDI transactions including enrollment, claims, financial, and eligibility transactions using ANSI X12 HIPAA compliant formats. - Provides technical support for the implementation of EDI connections with external parties. - Responds to inquiries related to EDI transactions. - Conducts analysis of EDI transactions. - Provides issue resolution when necessary. - Handles multiple enhancement requests and projects. Qualifications - Required: Associate's Degree or equivalent. - 2 years of relevant experience analyzing EDI data to identify content and/or formatting issues. - 2 years of relevant experience using SQL queries to retrieve and/or display data. - 2 years of relevant experience reading/analyzing/formatting/translating EDI data. - 2 years of relevant experience implementing EDI setup and mapping. - Preferred: Bachelor's Degree. - 2 years of relevant experience in the healthcare industry. - 2 years of relevant experience with Facets software or a similar healthcare enrollment/claims management software system. Requirements - Demonstrate knowledge of EDI standard formats and communicate complex data exchange concepts to internal and external parties. - Interface professionally with various internal and external customers including Operations, Sales, Marketing, IS, and Trading Partners to understand and process work requests. - Responsible for the implementation of electronic data interchange connections between Priority Health and external parties. - Support ongoing implementations in post-production, including error identification/resolution, continuous improvement, and pro-active communication with the trading partners and providers to reduce/prevent errors. - Verify and monitor EDI processes. - Troubleshoot and resolve EDI related issues. - Develop and maintain procedural documentation. - Follow-up comprehensively with all stakeholders during issue remediation process to assure that delays are minimized and the process runs smoothly. - Assist in defining application enhancements and upgrades. - Perform application configuration, mapping, and monitoring of EDI transactions and processes. - Support application testing effort by performing user acceptance testing (UAT) and assisting in defect resolution. - Provide on-call support as necessary. Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description The inpatient senior coder will thoroughly review inpatient record accounts to assign correct ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes per industry coding guidelines, utilizing the 3M computer assisted coding software application. Abstracts coded data from the Epic electronic medical record according to the established standard of work, while maintaining established quality accuracy and productivity standards. Works collaboratively with leadership, financial and clinical teams to ensure Diagnostic Related Groups (DRG) or All Patient Refined Diagnostic Related Groups (APR-DRG) accuracy. The outpatient senior coder will review multiple service lines of outpatient services (ambulatory surgery, observation, interventional radiology/cardiology, emergency) record accounts to assign correct ICD-10-CM diagnosis codes, CPT procedure codes, add modifiers, review claim edits, etc. per the industry coding guidelines, utilizing the 3M computer assisted coding software application. Abstract coded data from the Epic electronic medical record according to the established standards of work, while maintaining the established quality accuracy and productivity standards. Essential Functions - Consistently Meets Monthly Productivity Standard: ≥100% - Consistently Meets Biannual Quality Standard: ≥95% - Use of an electronic medical record and encoder in a remote work environment. - Codes outpatient or inpatient records according to coding guidelines and conventions. - Assigns diagnoses and procedures for billing process, data retrieval and research purposes, using numerical codes of ICD-9-CM/ICD-10-CM/PCS and CPT-4 coding. - Provides education and training regarding coding guidelines of specialty area to clinical and non-clinical staff. - Communicates, collaborates and acts as a team player with others in order to ensure continuity of services. - Optimize codes for reporting and generates APCs for all outpatient records. - Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. - Participate in process improvement activities including but not limited to assuring accounts that cannot be coded are held for valid reasons. - Must attend all staff meetings required by management. Qualifications - High School Diploma or equivalent - 2 years of relevant experience coding - 1 of 5 certifications: - CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association Upon Hire - CRT-Registered Health Information Technician (RHIT) - AHIMA American Health Information Management Association - CRT-Registered Health Information Administrator (RHIA) - AHIMA American Health Information Management Association - CRT-Professional Coder – AAPC / American Academy of Professional Coders - CRT-Outpatient Coder, Certified (COC) - CPC – Certified Professional Coder Requirements - Associate’s degree in health information technology/management (Preferred) - Bachelor's degree Health information technology/management (Preferred) - ICD-10-CM, ICD-10-CPS, CPT coding experience (Preferred) Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description Assist and educate patients, providers, medical office staff, and/or Health system staff with accessing services, facilitating and resolving problems, understanding navigation questions. Consistently create an exceptional experience with each contact, via inbound and outbound calls, online chat, email, etc. Adheres to established procedure and quality guidelines in support of Patient Access Services Center performance indicators, as well as Corporate values and codes of excellence. - Analyzes, evaluates, resolves and responds to service inquiries from members, providers, employer groups, colleagues, agents, Elite agents (customers), and others within departmental guidelines. - Professional and pleasant interactions are ongoing expectations. - Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status. - Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes. - Places outbound welcome calls to members to educate them on their benefits as needed. - Assists walk-in members and agents if assigned by leadership. - Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements. - Assists customers with administrative issues, such as submitting enrollment record changes, providing letters explaining coverage or benefits, and obtaining and relaying certain member information to other departments as needed. - Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments. - Effectively tracks and/or documents all service interactions with customers within appropriate systems according to guidelines. - Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule. - May be trained and then assigned to perform core scheduling duties for other service lines to meet fluctuating business demands. - Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis. - Performs other duties as assigned. Qualifications - High School Diploma or equivalent (Required) - 1 year of relevant experience (Required) - Associate’s degree (Preferred) Requirements - As part of our hiring process, you may be invited to complete an initial screening using an AI‑enabled voice agent. This screening focuses on job‑related qualifications and is reviewed by our hiring team as one part of the overall evaluation process. - The voice agent provides the opportunity for applicants to respond at a time that works best for them. The voice agent works 24/7 - just like healthcare! Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description Assist and educate patients, providers, medical office staff, and/or Health system staff with accessing services, facilitating and resolving problems, understanding navigation questions. Consistently create an exceptional experience with each contact, via inbound and outbound calls, online chat, email, etc. Adheres to established procedure and quality guidelines in support of Patient Access Services Center performance indicators, as well as Corporate values and codes of excellence. - Demonstrates high competency in responding to service inquiries from patients, providers within departmental guidelines. - Professional and pleasant interactions are ongoing expectations. - Assist patients, providers, practice staff, regarding accessing service lines, facilitating scheduling & registration tasks along with support of other non-routine questions, via inbound and outbound calls, postal mailing, online chat, TEAMS, email, etc., as outlined by standard work. - Able to perform in all disciplines within the respective service line and remains up to date on standard work changes, industry standards, policy changes, and operational improvements. - Identifies potential trends or issues that impact patients and service lines and works with coworkers and leadership resources to suggest process improvements. - Consistently meets standards of the On-Track performance and averaging consistently high QA audit scores. - Acts as an expert resource for team members through “in the moment” guidance (SME Line) and reinforcement of standard work guidelines and disciplines with new employees within the “at the elbow” presence (preceptor). - Maintains/updates knowledge of changes in standard work and guidelines and provides input. - Escalates transaction incidents to Lead/Supervisor/Manager for resolution. - Fluently communicates with all levels of leadership, manage up and lead laterally. - May be trained and then assigned to perform core scheduling duties for other service lines to meet fluctuating business demands. - Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis. - Performs other duties as assigned. Qualifications - High School Diploma or equivalent - 5 years of relevant experience in related field - 1 year of relevant experience in Revenue Cycle - Associate’s degree (Preferred) - 2 years of relevant experience in customer facing service on phone or face to face, customer service and/or managed health care (Preferred) Requirements - As part of our hiring process, you may be invited to complete an initial screening using an AI‑enabled voice agent. This screening focuses on job‑related qualifications and is reviewed by our hiring team as one part of the overall evaluation process. - The voice agent provides the opportunity for applicants to respond at a time that works best for them. The voice agent works 24/7 - just like healthcare! Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description Acts as a liaison between physician practices, rehab services, professional billing office, coding, payer relations, compliance and revenue management operations of patient financial services and Corewell Health. Provides assistance to management and employees. Conducts coding quality reviews for the coding department, rehab services and physician practices. - Meets with providers and coding employees regularly on billing, coding and reimbursement issues applicable to their specialty. - Reviews monthly reporting from billing system with a focus on revenue cycle metrics, unbilled accounts, and adequate documentation. - Acts as a liaison between the Coding department and Spectrum Health to enhance educational awareness of coding and documentation. - Participates and initiates process and quality improvement activities. - Reviews coding patterns/trends and provides ongoing consultation to providers regarding coding and documentation issues. - Proactively identifies and communicates problems and opportunities; actively recommends and implements solutions or process improvements. - Presents information to physicians, administrators and other institutional leadership. - Acts as an expert resource for administrators and physicians in regulatory, coding, billing compliance and financial functions. - Processing pended claims and provider appeals, which consists of reviewing medical records and using various coding resources to confirm correct coding. Qualifications - Bachelor's Degree in accounting, finance, health care administration, or related field or equivalent combination of education and experience. - 2 years of relevant experience progressive experience in various hospital functions (e.g., professional/facility coding, reimbursement, billing, and/or chargemaster maintenance). - CRT-Registered Health Information Administrator (RHIA) - AHIMA American Health Information Management Association Upon Hire required Or - CRT-Registered Health Information Technician (RHIT) - AAPC American Academy of Professional Coders Upon Hire required Or - CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association Upon Hire required Or - CRT-Professional Coder - AAPC American Academy of Professional Coders Upon Hire required. Requirements - Knowledge of CPT, HCPCS, CMS claim formats (1450 and HCFA 1500). - Knowledge of Microsoft (Word, Excel, Visio, OneNote, etc.). Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description The director is responsible for the development, implementation, maintenance, and support of imaging applications that enable cardiology and radiology services, as well as the domain architecture for Healthcare Services Applications within Care Delivery. In collaboration with both business and other digital services leadership, they assure alignment of the applications and platforms with the strategy and priorities of the organization. The director assures the reliable and cost-efficient operation of digital services by driving continuous improvement and rationalization of the services they are accountable for. They understand and manage the total cost of ownership for these services. They build a high performing team through hiring, managing, and coaching talent. They manage vendor and consultant relationships as necessary for their area of responsibility. They establish and maintain strong relationships with the customers for their area of responsibility. The director works with their team, other digital services leaders, and business/operational leaders to build out architecture roadmaps for the maturity of business and technology capabilities for the assigned area. They guide their team in alignment with enterprise architecture to establish reference architectures and architecture approaches for the assigned area. As a member of the digital services senior leadership team, the director works in collaboration with other leaders to represent digital services to the organization and advocate for digital transformation. Qualifications - Required: Bachelor's Degree or equivalent in related field - 10 years of relevant experience in healthcare digital services, information technology, enterprise imaging, or related disciplines. - 5 years of relevant experience in people, operational, technical, or project leadership roles. - 5 years of relevant experience leading enterprise imaging platforms, imaging applications, or imaging architecture initiatives within a healthcare environment. - Experience with healthcare imaging technologies including DICOM, HL7/FHIR integrations, EPIC Radiant/Cupid, or enterprise imaging ecosystems. - Vendor strategic partnership management experience leading enterprise vendor relationships and technology governance initiatives. - Preferred: Master's Degree - MHSA, MPH, MBA or related field - Experience leading enterprise imaging modernization initiative including PACS, RIS, VNA, enterprise imaging consolidation, cloud imaging, or interoperability initiatives. - Experience with digital transformation enterprise architecture initiatives including imaging platform modernization and application rationalization strategies. Requirements - Organizes the domain architecture for a large area of digital services. - Oversees the day-to-day work of a team of domain architects in collaboration with the digital services architecture program. - Plans, organizes and directs the design, development, acquisition and implementation of organization-wide applications and platforms for their area(s) of responsibility. - Responsible for the cultivation of top talent, as well as their hiring, management and succession within the organization. - Selects, trains, develops and evaluates team members and initiates personnel actions in accordance with policies and organization philosophy. - Maintains a diverse and inclusive team environment that produces unity, enabling strong relationships with customers and other collaborating roles. - Establishes performance standards for applications, platforms and teams under their direction. - Ensures that process and services are continuously monitored for quality, cost effectiveness and efficiency. - Manages the total cost of ownership (TCO) for the applications, platforms and services within their scope of responsibility. - Establishes goals and performance metrics for their team. - Reports out on progress with architecture roadmaps and strategies. - Establishes and coaches team to establish strong relationships with business, operational, and clinical leaders to facilitate the development of architecture roadmaps. - Maintains an understanding of key business strategies that may guide future architecture. - Engage with digital services architecture leadership and enterprise architects to help guide the organization through digital transformation. - Fosters a learning environment for their team and models this through continuous study of emerging trends and best practices. - Perform regular talent and financial management functions expected of management. - Develops, implements and maintains the expense and capital budget assigned to the area(s) of responsibility as applicable. - Actively participates in safety initiatives and risk mitigating measures where appropriate. - Completes all position and unit safety related competencies and requirements on a timely basis. - Performs other duties as assigned. Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description The Virtual Nurse (VRN) is an experienced Registered Nurse (RN) and integrated care team member who leverages technology to collaborate with and support the needs of the bedside RN and the patient/family virtually for Big Rapids, Greenville, and Fremont. Two-way audio/visual technology provides the virtual nurse the ability to assist with: - Admission and discharge activities - Patient and family education - Real-time patient quality and safety surveillance - Proactive rounding - Staff mentoring/education The purpose of this position is to harness the skills of an experienced RN to support and transfer knowledge to novice nurses within the organization, and to provide high-quality, remote nursing care in accordance with the established policies and procedures of Corewell Health. Delivers nursing care responsibly and accountably as described professionally by the American Nurses Association (ANA) and legally by the State of Michigan. Demonstrates competency through the critical thinking model known as the nursing process, which includes: - Assessment - Diagnosis - Outcomes identification - Planning - Implementation - Evaluation Upholds the standards of professional performance as described by the ANA, which includes: - Ethical practice - Culturally congruent practice - Communication - Collaboration - Leadership - Education - Evidence-based practice and research - Quality of practice - Professional practice evaluation - Resource utilization - Environmental health Strives to achieve optimal outcomes. Qualifications - Associates in Nursing Required - Bachelors in Nursing Required within 5 years - 2 years or more of adult medical surgical or adult ICU experience required - MI Registered Nurse (RN) Required - CRT-Basic Life Support (BLS) - AHA American Heart Association 90 Days required - Additional certifications may be required by home clinical department Requirements - Candidate must be located within 1 hour of one of the following Corewell Hospitals: Big Rapids, Greenville, or Fremont - Candidates must maintain an active bedside nursing role in addition to this virtual position Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals - On-demand pay program powered by Payactiv - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance, pet insurance - Traditional and Roth retirement options with service contribution and match savings - Eligibility for benefits is determined by employment type and status

Role Description Coordinates the maintenance of assigned departmental revenue cycle business systems, chargemasters, or other business processes, ensuring accuracy and consistency with departmental requirements and regulatory agency standards. Accountable for tasks impacting organizational cash flow, compliance, patient satisfaction and confidentiality. Monitors and trends data for assigned revenue cycle departments and tasks. - Reviews and makes recommendations regarding hospital or professional charges / fee structure, revenue cycle business systems, or related processes. - Researches patient access, coding and billing requirements when new procedures or regulatory changes are introduced. - Coordinates required updating of CPT / HCPCS codes, bill edits, third party payer changes or other revenue cycle regulatory requirements. - Assists in the resolution of revenue cycle issues, such as patient access, billing or denials, and develops systems to proactively address trends. - Facilitates the development of strategies for the evaluation and implementation of assigned tasks, such as recommended changes to business systems, reimbursement methodologies, or revenue cycle efficiencies, working collaboratively with teams / task forces / consultants. - Communicates, collaborates and acts as a consultant to others within and outside the department related to assigned tasks, in order to facilitate continuity and coordination of services. - Acts as a liaison to outside consultants and keeps upper management / revenue cycle team informed concerning progress / problems. - Assesses the educational needs of others related to area of accountability and coordinates / implements appropriate teaching strategies or makes appropriate referrals. Qualifications - Bachelor's Degree or equivalent in related field - 2 years of relevant experience in different areas of the health system such as billing, coding, reimbursement, technology & information solutions, and/or finance. Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance, pet insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description Work in partnership with leadership and various operational teams and organizational departments to oversee small to medium functional projects or phases(s) of a larger project. Responsible for all aspects of the project or a phase of a larger project. Acts as a change agent to create and support a positive change process. - Oversees small to medium sized, multi-faceted projects varying in complexity and involving cross functional experts. - Coordinates project work including project plans and schedules, and completes projects on time and within budget. - Analyzes and documents processes, procedures and outcomes to seek continuous improvement. - Assesses resource requirements for project tasks and works with leaders of functional areas and subject matter experts to meet project plan deliverables. - Communicates, collaborates, networks and acts as a consultant to stakeholders/business partners to ensure continuity and coordination of services and appropriate utilization of resources. - Serves as a liaison for projects between various departments within the system. - Acts as a change agent to advance the knowledge and use of project management. Qualifications - Required: Bachelor's Degree or equivalent - 2 years of relevant experience of applicable business function experience or other related experience - 2 years of relevant experience of related experience, preferably in project management - Preferred: Master's Degree - CRT-Project Management Professional, Associate (CAPM) - UNKNOWN Unknown - CRT-Project Management Professional (PMP) - PMI Project Management Institute Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance, pet insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description Partners with the business to turn data into critical information and knowledge. Possesses an advanced understanding of healthcare and/or data and analytics. Develops reporting and analytic solutions with knowledge of the primary source data (i.e., electronic health records, claims) and workflows. Develops relationships with internal and external users for direct consumption or integration with other systems. This role promotes data literacy by educating and training customers to use the data as an analytical tool, displaying the information for the purpose of analysis and exploration. Without supervision, designs, codes, configures, tests, debugs, deploys, documents, and maintains programs. Uses a variety of software development tools, programming languages, and testing/verification applications. This role creates and adheres to development best practices and quality standards. Gathers business requirements and translates the information into detailed technical specifications from which programs will be written or configured, and to validate that the proposed applications align with both the architectural design and business needs. Works closely with other BIDs, Data Engineers, Data Scientists, and internal/external customers. Coaches less experienced Business Intelligence Developers. Essential Functions - Designs, codes, configures, tests, debugs, deploys, documents, and maintains self-service reporting assets. - Understands Extract, Transform and Load (ETL) for populating data warehouse assets and sending data outside of data warehouse assets. - Translates and documents business program needs into a technical solution using visuals and creating data sources, metrics, and automation. - Creates visuals, data sources, and automation from electronic health record (EHR) reporting tools and databases (i.e., Clarity, Caboodle, Epic Registries, Epic Extract Framework, Custom Radar SQL metrics, Data Links, and Predictive Model configuration), cloud reporting systems (i.e. Snowflake), and other EHR agnostic tools (i.e. SSIS, GoAnywhere, Tableau, PowerBI, etc.). - Presents technical solutions to key stakeholders. - Provides advanced analytics that can turn data into critical information in understanding a systemic business problem. - Independently provides troubleshooting, maintenance, support, oversight, and technical guidance. - Possesses knowledge of workflows in multiple business areas to support data development, analytics, and quality improvement activities. - Guides less experienced Business Intelligence Developers in gaining workflow knowledge. - Performs job-related duties in conformance with digital services standards and initiates and leads team through new/improved standards. - Participates in agile ceremonies determining the nature and scope of project activities and processes to be developed or modified. - Works with data engineers and data architects to verify that relational and dimensional data models meet use cases and align with strategic direction. Qualifications - Bachelor's Degree or equivalent in business, liberal arts, computer science, application programming, software development, information systems, database administration, mathematics, engineering, or other related field. - 5 years of relevant experience. - 6 months of relevant experience Epic Cogito certification within 6 months of employment. Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance, pet insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.