UofL Health

• Works under the direction of the Pharmacy Manager or Supervisor • Serves as a liaison to patients/caregivers, physicians, and other medical staff • Identifies, facilitates, and orders prescription medications • Manages and performs financial/billing/clinical audits • Verifies accurate insurance and demographic information • Coordinates patient encounters utilizing multiple system applications

Role Description The Epic Prelude and Cadence Analyst is responsible for the design, configuration, implementation, optimization, and ongoing support of the Prelude and Cadence application within the Epic electronic health record (EHR) system. This role collaborates with Patient Access, Revenue cycle operations, clinical departments, information technology teams, and organizational leadership to support efficient billing workflows, ensure regulatory compliance, and promote revenue integrity. The Analyst serves as a subject matter expert in provider billing, charge capture, claims processing, reimbursement methodologies, and reporting. Core responsibilities include: - Analyze current-state business workflows and design system-based improvements to enhance operational efficiency and reduce claim denials. - Develop, coordinate, and execute testing plans for system upgrades, enhancements, and patches. - Collaborate with Patient Access, revenue cycle teams, IT personnel, and clinical departments to align system functionality with operational and business requirements. - Perform system upgrades, maintenance, and validation activities to ensure compliance with applicable healthcare laws and regulations. - Partner with training teams to develop, maintain, and update user education materials and documentation. - Adhere to organizational application change management policies and procedures. - Monitor changes in healthcare regulations and payer requirements; ensure system and process compliance. - Develop and maintain policies and procedures to support regulatory and operational requirements. Qualifications - Bachelor’s Degree required or Minimum of four (4) years of relevant Patient Access or revenue cycle experience in lieu of a degree. - Minimum of three (3) years of experience in healthcare information technology or Patient Access related experience. - Demonstrated knowledge of Epic EHR functionality, particularly Prelude and Cadence modules. - Preferred: At least one (1) Epic certification. - Strongly preferred: Epic certifications in both Prelude and Cadence. - Additional plus: Epic certifications in Decision Tree, Referrals, RTE, Welcome, and Data Courier Mover Badge. - If Candidate does not hold the Preferred certification at the time of hire, it must be obtained within ninety (90) days of employment and maintained in an active status throughout the duration of employment. Requirements - Strong analytical and problem-solving skills, with the ability to identify issues, evaluate data, and implement effective solutions to improve financial performance. - Knowledge of healthcare financial operations, reimbursement methodologies, and regulatory compliance requirements. - Ability to apply industry standards and best practices to organizational needs. - Effective verbal and written communication skills. - Requires excellent oral and written communication skills. - Requires strong problem-solving and analytic skills. - Proficiency in Microsoft Office applications (e.g., Word, Excel, PowerPoint). Benefits - Other responsibilities as assigned. Company Description UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center. With more than 12,000 team members—physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals—UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.

Role Description The Research Regulatory Manager position is responsible for developing the training and education for researchers as needed to meet the regulatory requirements to conduct clinical research studies in UL Health. The position will build and maintain relationships with physicians, nurses, IT, Marketing, Supply Chain, and leadership as needed to promote and support research. It assists with the development of goals, policies, and procedures for oversight of clinical research. The position is responsible for monitoring compliance with policies, procedures, and governing regulations, including the informed consent process and HIPAA authorizations. It works closely with researchers and the corporate compliance team to identify and mitigate risks through education and process development. The position is responsible for oversight of IRB submissions, study review process, and research personnel vetting. Essential Functions - Develop training and education related to research processes and procedures and present to stakeholders. - Audit and monitor the informed consent process for research conducted within UL Health. - Assist in preparation for study monitoring visits for CMG studies. Review monitoring visit findings and provide training and education as needed. - Work with the Health Information Management team and researchers to ensure adequate documentation in medical records. - Train and supervise the Research Regulatory Coordinators, overseeing IRB process and research personnel vetting process. - Facilitate and lead planning meetings for new studies as needed and serve as liaison to internal stakeholders, such as marketing, IT, supply chain, and patient care teams. - Oversee facility and systems access for study monitors. - Review all study submissions to ensure HIPAA compliance prior to facility approval. - Exempt position works 80 productive hours each pay period and is paid biweekly. - Daily hours are flexible as long as no less than 80 productive hours are worked. - On occasion, the position may require additional hours to meet deadlines or for special projects. Other Functions - Review completed consent forms for accuracy and congruence with contracts. - Review protocols, waivers, consent documents, and data collection sheets to determine if any changes are needed for HIPAA authorization to be congruent with protocol. - Perform other duties as assigned. Qualifications - Bachelor’s degree (required) - Experience in clinical research, human subjects’ protection regulations, including HIPAA authorizations, and IRB process (required) - 5 years of experience in research administration (preferred) Licensure - None (required) - None (preferred) Certification - Professional certification such as CCRP, CHRC, ACRP-CP (preferred)

• Abstract and assign valid CPT, ICD-10, HCPCs, and modifiers • Ensure appropriate reimbursement in accordance with guidelines • Identify compliance concerns and education opportunities • Work with limited oversight and direction on complex cases

Role Description This position is responsible for reviewing patient medical records to facilitate modifications to clinical documentation through concurrent (pre-bill) interaction with providers and other members of the healthcare team to promote accurate capture of clinical severity of illness and risk of mortality (later translated into coded data) and to support the level of service rendered to relevant patient populations. CDIS exhibits expert knowledge of clinical documentation requirements, MS-DRG Assignment, case mix index (CMI) analysis, clinical disease classifications, major and non-major complications and comorbidities (MCCs or CCs), and quality-driven patient outcome indicators. Interacts as needed with internal customers to include but not limited to hospital staff, physicians, and other revenue cycle team members. Actively participates in department and hospital performance initiatives when needed to ensure ULH success. Responsibilities - Completes initial medical record reviews of all inpatient patient accounts (all payers) within 24-48 hours of admission for a specified patient population to: - Evaluate and review inpatient medical records daily, concurrent with patient stay, to identify opportunities to clarify missing or incomplete documentation. - Assign the principal diagnosis, pertinent secondary diagnoses, procedures for accurate MS-DRG assignment, score risk of mortality and severity of illness and initiate a review worksheet. - Conduct follow-up reviews of patients every 2-3 days to support and assign a working or final MS-DRG assignment upon patient discharge, as necessary. - Formulate clinically compliant and credible physician queries regarding missing, unclear or conflicting health record documentation by requesting and obtaining additional documentation within the health record, as necessary. - Proactively collaborate with physicians to discuss and clarify documentation inconsistencies to ensure accuracy of the medical record and appropriate capture of the course of treatment provided to the patient. - Educate providers about identification of disease processes that reflect SOI, complexity, and acuity to facilitate accurate application of code sets. - Gather and analyze information pertinent to documentation findings and outcomes, and use this information to develop action plans for process improvements. - Collaborate with case managers, nursing, and other ancillary staff regarding interaction with physicians concerning documentation opportunities and to resolve physician queries prior to discharge. - Communicate/completes Clinical Documentation Improvement (CDI) activities and coding issues (lacking documentation, physician queries, etc.) for appropriate follow-up and resolution with appropriate leadership. - Remain abreast and current on training of new hires and ongoing CDIS professional staff development as well as participate in CDI-related continuing education activities to maintain certifications and licensures. - Collaborate with HIM/coding professionals to review and resolve DRG mismatches for individual problematic cases and ensure accuracy of final coded data in conjunction with CDI managers, coding managers, and/or physician advisors. - Identify patterns, trends, variances, and opportunities to improve documentation review processes. - Aid in identification and proper classification of complication codes and present on admission (POA) determination (patient safety indicators/hospital-acquired conditions) by acting as an intermediary between coding staff and medical staff. - Contribute to a positive working environment and perform other duties as assigned or directed to enhance the overall efforts of the organization. Qualifications - CDIS candidate must have and maintain current licensure as a RN, RHIA, RHIT or possess an active CCS (AHIMA) or CPC-H (AAPC) coding credential. - CDIS must have 3+ years of acute care experience as a RN or 3+ years inpatient coding experience as a RHIA/RHIT/CCS/CPC-H. - Must have advanced clinical expertise and extensive knowledge of complex disease processes with broad clinical experience in an inpatient setting. - Certified Clinical Documentation Specialist or Clinical Documentation Improvement Professional (CCDS or CDIP) credential is required within 12 months of employment. Requirements - Working knowledge of medical terminology and Official Coding Guidelines. - Ability to work independently, self-motivate, and adapt to the changing healthcare arena. - Excellent verbal and written communication skills, analytical thinking, and problem solving with strong attention to detail. - Proficiency in organizational skills and planning, with an ability to multitask in a fast-paced environment. - Proficiency in computer use, including database and spreadsheet analysis, presentation programs, word processing, and Internet research. - Working knowledge of federal, state, and private payer regulations as well as applicable organizational policies and procedures. - Working knowledge of quality improvement theory and practice, core measures, safety, and other required reporting programs. - Ability to formulate clinically compliant and credible physician queries.

Role Description Medical insurance verification of patient accounts to determine eligibility, benefits and co-pays due and ability to analyze patient accounts for outstanding balances as well. Must be detail oriented and possess strong communication and interpersonal skills with the ability to multi-task. - Verifies patient eligibility six days out from appointment - Determines patient’s benefits including deductibles, co-insurance and co-pay amounts - Verifies if authorizations are required and obtain, if necessary - Verifies benefits - Calls patients prior to appointment if there is a problem with patient’s insurance - Works with patients to pay balances on account or create payment plan for balances due - Works hold bill and marked event alerts - Determines what is needed for the upcoming visit (e.g., consent, arrival form, ID, insurance card, picture, etc.) - Works visit insurance and arrange FSC accordingly Qualifications - High school diploma or GED/Equivalent (required) - Five (5) years of insurance experience (preferred) Requirements - Understanding of insurance policies and processes - Ability to utilize insurance websites proficiently - Ability to anticipate and adapt to change positively - Must possess solid customer service skills - Strong interpersonal and communication skills - Demonstrated organizational skills - Strong work ethic - Proven ability to work on a team - Maintains a professional appearance at all times - Must be able to communicate effectively in both verbal and written formats - Strong investigative and problem solving skills - Proficient in Microsoft Office - Extensive knowledge of Centricity Benefits - Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times - Maintains confidentiality and protects sensitive data at all times - Adheres to organizational and department specific safety standards and guidelines - Works collaboratively and supports efforts of team members - Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community

• Manage the appeal of unpaid claims in the Central Business Office • Work closely with insurance carriers in resolving unpaid claims • Review and appeal unpaid claims daily • Completes follow-up work on appealed claims • Works with insurance carriers on appeal issues • Provides feedback to the coding department with coding errors or updates • Review remit to ensure accurate payment was received • Reviews denials for accuracy • Obtains all necessary information to expedite the appeal process • Closes and prints daily batch proof • Makes charge corrections as needed in the practice management system • Attends continued education programs for coding • Other duties as assigned

Role Description The Oncology Data Specialist serves as a valuable resource for oncology data, working in collaboration with physicians, administration, researchers, the oncology team, and other hospital departments. The Oncology Data Specialist ensures timely, accurate, and complete oncology data for the purpose of monitoring oncology outcomes, assessing patterns of care, monitoring quality of care and clinical practices, quality management and improvements, and program development. The Oncology Data Specialist follows data collection, reporting, and quality standards for compliance to the state, federal and oncology accreditation and regulatory agencies while managing and analyzing clinical information for education, research, and outcomes measurement. - Performs abstraction of patient cancer data into the cancer registry database by reviewing and interpreting complex diagnostic and treatment data from the hospital and physician office records. - Abstracts are efficiently and accurately codified using standards and practices defined by the American College of Surgeons (ACoS), Surveillance Epidemiology and End Results (SEER), American Joint Committee on Cancer (AJCC), and North American Association for Central Cancer Registries (NAACCR). - Utilizes all available data to assign staging to each applicable site, coding as required by above standard setters. - Performs case ascertainment to maintain a complete cancer registry database. - Identifies patients from ICD-10 codes of reportable malignant and benign diseases by reviewing pathology/cytology reports, diagnostic imaging reports, and physician dictation on inpatient and outpatient visits. - Identifies patients from radiation and medical oncology patient visits and determining reportability based on class of case after review of records. - Conducts data analysis and reports based on abstracted cancer registry data. - Prepares upon request reports on cancer patient data for the medical staff, medical students, Residents, Fellows, and hospital administration for the purposes of research and program development. - Ensures all reports are complete, accurate, high quality, and timely. - Performs high level follow up activities on all living patients abstracted into the cancer registry database, verifying cause of death using death certificate clearance process, and monitoring patients for their lifetime following the cancer diagnosis to assess the effectiveness of treatment. - As required for oncology accreditation, 90% of all living patients must have annually updated contact. Qualifications - Associate degree (60 college credits) or completion of/enrollment in National Cancer Registrars Association-Accredited Certificate Program (required) - Human Anatomy and Human Physiology (6 total credit hours) (required) - Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) (preferred) Requirements - One year in a hospital or physician practice setting or 160-hour Clinical Practicum preparation for Certified Tumor Registrar exam (required) - Two years in a hospital or state cancer registry (preferred) - All employees in role must be eligible for the Certified Tumor Registrar (CTR) by the National Cancer Registrars Association (required) - If not already obtained, all new hires must obtain Certified Tumor Registrar (CTR) within two years of hire (required) Benefits - Assist in registry operations including training and developing new staff, creating and updating policies and procedures, participation on committees and participation in education as required to obtain the ODS certification and meet compliance with accreditation standards. - Participate in oncology accreditation activities, which includes case abstraction and continued monitoring of patients listed in the quality tools provided by the accrediting body (i.e. the Commission on Cancer Rapid Cancer Reporting System). - Maintains compliance with all company policies, procedures and standards of conduct. - Complies with HIPAA privacy and security requirements to maintain confidentiality at all times. - Performs other duties as assigned.

Role Description The Oncology Data Specialist serves as a valuable resource for oncology data, working in collaboration with physicians, administration, researchers, the oncology team, and other hospital departments. The Oncology Data Specialist ensures timely, accurate, and complete oncology data for the purpose of monitoring oncology outcomes, assessing patterns of care, monitoring quality of care and clinical practices, quality management and improvements, and program development. The Oncology Data Specialist follows data collection, reporting, and quality standards for compliance with state, federal, and oncology accreditation and regulatory agencies while managing and analyzing clinical information for education, research, and outcomes measurement. - Performs abstraction of patient cancer data into the cancer registry database by reviewing and interpreting complex diagnostic and treatment data from the hospital and physician office records. - Abstracts are efficiently and accurately codified using standards and practices defined by the American College of Surgeons (ACoS), Surveillance Epidemiology and End Results (SEER), American Joint Committee on Cancer (AJCC), and North American Association for Central Cancer Registries (NAACCR). - Utilizes all available data to assign staging to each applicable site, coding as required by above standard setters. - Performs case ascertainment to maintain a complete cancer registry database. - Identifies patients from ICD-10 codes of reportable malignant and benign diseases by reviewing pathology/cytology reports, diagnostic imaging reports, and physician dictation on inpatient and outpatient visits. - Conducts data analysis and reports based on abstracted cancer registry data, including calculation, analysis, and interpretation of data related to cancer occurrence, treatment, management, and outcomes. - Prepares reports on cancer patient data for the medical staff, medical students, Residents, Fellows, and hospital administration for the purposes of research and program development. - Performs quality assurance and auditing of registry data to ensure accurate, consistent, and complete data. - Performs high-level follow-up activities on all living patients abstracted into the cancer registry database. - Verifies cause of death using death certificate clearance process and monitors patients for their lifetime following the cancer diagnosis. Qualifications - Human Anatomy and Human Physiology (6 total credit hours) or equivalent job experience (required) - Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) (preferred) - One year in a hospital or state cancer registry (required) - Two years in a hospital or state cancer registry (preferred) - Oncology Data Specialist-Certified (ODS-C) by the National Cancer Registrars Association (required) Requirements - Medical Terminology - Familiarity with requirements related to protected health information (PHI) and/or HIPAA - Detail-oriented in gathering relevant data while attending to essential details - Strong initiative - Ability to work independently - Must be able to communicate effectively in both verbal and written formats - Must be comfortable speaking to groups, such as with committee meetings - Must have ability to interpret an extensive variety of instructions and deliver results - Must have ability to define problems, collect data, establish facts, and draw valid conclusions - Must have ability to critically think through complex situations and make determinations based on presented data - Typing at least 60 words per minute - Proficient in Microsoft Office products including Excel, Word, PowerPoint - Capacity to learn other relevant systems and hospital medical records - Knowledge of database management Benefits - Demonstrates a commitment to service, organization values, and professionalism through appropriate conduct and demeanor at all times. - Maintains confidentiality and protects sensitive data at all times. - Adheres to organizational and department-specific safety standards and guidelines. - Works collaboratively and supports efforts of team members. - Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff, and the broader health care community.

• Supervise hospital claims billing and follow up to maintain unbilled and accounts receivable inventory within KPI metrics and industry standards. • Educate and train staff on proper workflows, policies, and standards. • Researches payer billing requirements and provides guidance to resolve outstanding accounts receivable balances. • Keeps up to date with payer claims processing requirements and government regulations. • Focuses on high dollar receivable accounts and adjust staffing as necessary. • Assists in the development of standards and policies pertaining to hospital claims billing and follow up. • Monitors and resolves claims holding on discharged not final billed (DNFB) list. • Identifies payers being submitted on paper rather than electronically and communicate the opportunities to leadership. • High dollar accounts will have consistent follow up until the account has been resolved. • Responsible for reviewing and understanding explanation of benefits/remittance advice. • Performs extensive account follow-up reviews and provide analysis of problem accounts.