UofL Health

• 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

Role Description This position is responsible for managing the appeal of unpaid claims in the Central Business Office. This position will also work closely with insurance carriers in resolving unpaid claims. Job Responsibilities - 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. - Reviews 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 continuing education programs for coding. - Other duties as assigned. Qualifications - High School education or GED required. - Must have and maintain Certified Professional Coder (CPC) certification through AAPC or must have and maintain CCA, CCS or CCS-P certification through AHIMA. Requirements - 3 years of prior coding experience, preferred. - Prior experience working with medical insurance.

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.

Role Description The Clinical Support Pharmacy Technician assists with all phases of pharmacy services and performs a variety of clinical functions and dispensing tasks in support of the daily workflow of the ULH Specialty Pharmacy. This position supports the Specialty Pharmacy team with implementation and administration of clinical programs, including the management of specialty pharmacy products and program reporting. The Clinical Support Pharmacy Technician will also function as a member of the ACB Outpatient Retail Pharmacy team as the Specialty Pharmacy liaison. Essential Functions - CLINICAL - Assists pharmacist in providing pharmaceutical care to include (but not limited to): - Conduct medication adherence and refill calls to patients. - Communicate with provider offices and in-network pharmacies regarding patient care and various clinical specialty pharmacy initiatives. - Screen phone calls/orders and alert the pharmacist to patient-specific needs. - Gather clinical information on patients including labs, immunizations, upcoming appointment schedule, etc. as required by the provider’s protocol. - Routinely records medication histories on all patients for completeness and accuracy. - Provide accurate and pertinent clinical documentation in the appropriate pharmacy IT application system. - Alerts the pharmacists to any adverse drug events, labs, or needs of the patient requiring clinical judgement and prescriber intervention. - DISPENSING - Receives and accurately reads, interprets and enters medication orders in system. - Accurately obtains patient history information upon receipt of prescription including address, date of birth, phone number, drug allergies, disease states and third-party information. - Collaborates with the medication access coordinators regarding authorization processes, co-pays, patient assistance programs and foundation support. - Packages, labels and prepares final product for shipping in accordance with pharmacy policies and procedures. - Performs duties in documented accordance with requirements of all regulatory and governing bodies. - Performs insurance billing and administrative support functions. - Assists in procurement, receipt and proper storage of drugs and general supplies. - Maintains appropriate stock levels within work area and routinely manages specialty pharmacy inventory. - OPERATIONAL - Initiate and participate in Specialty Pharmacy performance improvement processes and Quality Improvement initiatives as per accreditation regulations. - Assist in ensuring department compliance with accreditation, legal, regulatory & safety requirements. - Support and participate in policy & procedure development as related to operational and clinical processes. - Understand and adhere to all accreditation reporting standards and expectations; identify and help resolve areas of needed improvement. - Other duties as assigned by management. - EDUCATIONAL - Provide education related to specialty pharmacy to meet the needs of patients, pharmacy staff and other healthcare professionals through publications, presentations and/or programs. - Support and help develop objectives to facilitate student and resident training. - FINANCIAL - Ensure cost effective treatment in specialty practice area. - Seek financial remuneration and third-party reimbursement for pharmacy services. - Communicate financial responsibilities with patients effectively and collects payments prior to delivery. - Know and follow all regulations and guidelines pertinent to dispensing medications and supplies to Medicare patients. Additional Responsibilities - Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times. - Adheres to and exhibits core values: - Integrity: Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness. - Excellence: Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality. - 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. Skills, Knowledge or Abilities critical to this role - Knowledge of the standards, techniques and tools relating to pharmaceutical patient care. - Ensure that prescription order management is organized, prioritized and systematic for insurance investigation, order processing, as well as in the coordination of shipping to the customer. - Ensure that all prescription orders are processed in a timely manner according to the need by/start date indicated on the order form. - Works as a liaison with the ACB Outpatient Retail Pharmacy team to facilitate prescription order processing of specialty pharmacy medications. - Ensure that all customer service related issues are handled promptly, effectively and in a satisfactory manner. - Knowledge of mathematical functions, including addition, subtraction, multiplication, basic algebra and calculations. - Knowledge of and/or willingness to learn of the sources and availability of medications, bio-technology products, pharmaceutical supplies and equipment and related items specific to specialty pharmacy. - Ensure that no prescriptions are left behind or left unfinished at the end of each day by personally reviewing all pending orders yet to ship. - Able to problem-solve with decisiveness and urgency through completion and asking for assistance when needed. - Collaborate with the medication access coordinators and sales partners in the field letting them know of any patient or practice issues/concerns as well as new prescription from new prescribers. - Must be detail oriented and have the ability to multitask and complete assignments in a timely manner. - Willingness to learn and become a specialty pharmacy subject matter expert. Customer Service - Strong phone skills. - Demonstrate superior level of customer service. - Relate well and communicate effectively with other employees and patients. Computer Skills - Ability to use office equipment and automated systems/applications/software at an acceptable level. - Microsoft Office: Outlook, Word and Excel. - Cerner, Therigy, EPIC, other application as required. - ScriptPro, preferred. Education / Accreditation / Licensure - High school/GED. - Registered as pharmacy technician with the State Board of Pharmacy Examiners. - PTCB certification preferred. - Strong positive references. Experience - 2 years or more of work experience in pharmacy, Specialty Pharmacy preferred. - Minimum 2 years of customer service experience, required.

Role Description Under general direction, responsible for application and integration of information technology in the healthcare setting. This position will serve as a liaison between the IT department and operations to align system design with operational processes. This includes data collection, workflow analysis, system configuration, testing, and support. Participates in application deployment and procedure documentation. Ensures that the software build meets organizational goals and external mandates such as HIPAA and Meaningful Use. Has technical knowledge of all phases of applications system analysis and project management. Acts as project coordinator for medium sized projects with medium budgets and may or may not have system-wide implications. - Acting as the primary support contact for the application's end‐users - Identifying issues that arise in their application area as well as issues that impact other application teams, and working to resolve them - Guiding workflow design, building and testing the system, and analyzing other technical issues associated with Epic software - Identifying and implementing requested changes to the system - Serving as a liaison between end users' workflow needs and Epic implementation staff - Maintaining regular communication with Epic representatives, including participating in weekly project team meetings - Working with Epic representatives, your organization's business community, and end users to ensure the system meets the organization's business needs in regard to the project deliverables and timeline - Developing an understanding of operational needs to set the direction for the organization's workflows by attending site visits and other integrated sessions - Participating in training and working with end users - Troubleshooting problems and questions - Reviewing the status of projects and issues on an ongoing basis with leadership - Holding weekly communications with team members to discuss the status of deliverables, shared issues, end‐user concerns, budget, and upcoming milestones Qualifications - Minimum of a bachelor’s degree and four years' related experience, or two years' direct experience in lieu of a degree. Appropriate certification or licensure (if applicable) required. - Demonstrated progressive experience with on-line information systems; healthcare environment preferred. - Strong analytic and organizational skills, particularly in planning, communications, process redesign, and problem solving. - Ability to work effectively with a diverse group of users who have a varying level of computer expertise. - Understanding of the operational practices of scheduling and payer authorization, including nuances of provider schedules within your organization, scheduling practices for certain types of visits, and how these practices relate to the medical record flow for appointments. - Knowledge of areas that integrate with Cadence, including check‐in, registration, benefits, referrals, PCP assignment, and orders.

• Responsible for providing overall day to day guidance related to employee pay including Time and Attendance, Payroll, tax and Pay Statements • Work collaboratively with the members of the Finance, I/S and human resource team • Accountable for providing support to the Payroll Specialists • Manage the timely and accurate processing of payroll, tax and related payroll data • Serve as an internal payroll liaison for the payroll systems and the HRIS team • Develop and recommend policy and procedural changes to payroll functions • Provide a high level of customer service to ensure that employees and managers receive accurate, timely and appropriate information regarding payroll • Maintain employee payroll records and documents • Provide reports for payroll, time and attendance, employee statistics, benefits and retirement plan contributions and employer match • Stay up to date on federal, state, and local payroll and tax laws, policies, and procedures",