VCU Health

• Supporting insurance and registration Workqueues and other patient access functions for Ambulatory Business Operations • Ensuring entire scope of financial clearance activities for assigned patients before the scheduled appointment date • Confirming completeness of patient registration data • Verifying insurance eligibility • Confirming health plan benefits • Procuring PCP referrals and health plan authorizations • Calculating/collecting patient liability estimate • Restricting/redirecting out of network patient • Communicating patient financial responsibility • Ensuring patient financial responsibility is communicated with consistency, clarity, and transparency • Contributing to streamlining clinical operation work flows and improving revenue cycle operations and financial performance

Role Description The Credentialing Coordinator is responsible for all aspects of the initial credentialing, re-credentialing and privileging functions for all clinicians on medical and allied health staff at the VCU Health System Hospitals. - Interacts with clinicians to obtain applications and pertinent documents. - Evaluates data for accuracy and completeness. - Monitors receipt and follow-up responses ensuring timely and efficient processing. - Notifies supervisor Director of any adverse, incomplete or questionable data. - Works independently and assesses situations to choose appropriate courses of action. - Demonstrates sound organizational ability and effectively sets priorities. - Maintains strict confidentiality and professional discretion. - Ensures compliance with hospital bylaws and local, state, and federal requirements. - Provides assistance to the Director in development, plans, organization, and control of the operation of the Medical Staff Office. - Attends medical staff committee meetings as directed. - Interacts and provides support services to medical staff officers, departments, and chairs as assigned. Qualifications - Certified Provider Credentialing Specialist (CPCS) preferred. Requirements - Minimum of three (3) years previous credentialing and medical terminology experience in a hospital or managed care credentialing setting. - Previous experience using a personal computer and various applications, including Microsoft Office Access, Word, and Excel, and credentialing software. - Five (5) years of previous experience in credentialing in a health care environment (preferred). - Previous experience with the application of JCAHO, URAC, and NCQA guidelines (preferred). - Certified Professional in Medical Services Management (CPMSM) (preferred). - Associates or Bachelors degree or experience in lieu (required). - Associates or Bachelors Degree in Business, Healthcare or closely related field (preferred). Benefits - Expresses ideas and exchanges information clearly and concisely. - Demonstrates the ability to prioritize work assignments effectively and efficiently. - Develops effective relationships with other team members. - Highly motivated individual with independent work habits. - Organizational skills, proficiency in MS Office Access, Word, and Excel, and credentialing software. - Ability to multi-task in stressful and limited time constrained environment. - Knowledge of local, federal and state laws and regulations and JCAHO standards. Physical Requirements - Physical: Lifting 20-50 lbs. - Activities: Prolonged standing, Frequent bending, Walking (distance), Reaching (overhead, extensive, repetitive). - Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking. - Emotional: Fast pace environment, Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Able to adapt to frequent change.

Role Description The Reimbursement Specialist improves revenue collection pertaining to high cost medications that require prior authorization. This job will initiate, follow-up, and proceed with approval and/or denials of prior authorizations efficiently via phone, fax, or electronically. The Reimbursement Specialist carries out benefit investigation and coordinates Patient Assistance Programs and/or copay cards for patients with high co-pays or those without insurance coverage. This role works closely with nursing and physicians in order to obtain required documentation for prior authorization and billing. The Reimbursement Specialist arranges refills, transfers, and delivery of medications. Updates patient case management system regularly. Ideally, this role is familiar with disease state terminology or willingness to research. This role also works as a Pharmacy Technician when deemed necessary. Qualifications - Current certification by the Pharmacy Technician Certification Board (PTCB) - Current licensure with the Virginia State Board of Pharmacy - Minimum of one (1) year of previous pharmacy practice experience in a similar setting - Minimum of three (3) years of prior experience with Manufacturers Patient Assistance Programs and prior experience with prescription on-line adjudication - Previous work experience using a personal computer and various billing software applications as well as e-mail, spreadsheets, word processing, databases, etc. - High School Diploma or equivalent - Associate's Degree in Business or related field from an accredited program (preferred) Requirements - Identifies equipment problems; various aspects of assisting the pharmacist that don’t require a pharmacist's supervision or check. - Able to work all shifts, weekends, holidays, emergency coverage - Physical: Lifting less than 20 lbs. - Activities: Prolonged standing, Prolonged sitting, Frequent bending, Walking (distance), Climbing (steps, ladder, other), Reaching (overhead, extensive, repetitive), Repetitive motion - Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking - Emotional: Fast pace environment, Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Noisy environment, Able to adapt to frequent change Company Description

Role Description Are you passionate about building real-world AI that improves lives? In this role, you’ll collaborate directly with clinicians, operational SME's, clinical researchers, and IT peers to design and deploy machine learning solutions that improve operational efficiencies in healthcare administrative areas and advance clinical care, helping shape the future of patient care. A background in healthcare is highly desirable, as you’ll help translate clinical challenges into AI-powered solutions. You’ll work on production-grade ML systems, explore emerging technologies like agentic AI and AR/VR, and build clinical decision support tools that can have a real impact on patient outcomes. If you’re a senior engineer who thrives at the intersection of engineering, research, and medicine — we’d love to meet you. The AI Engineer III role is responsible for advanced analytics applying statistical, mathematical, and computational models to diverse datasets to solve clinical and business problems and identify breakthrough opportunities. This position is responsible for performing sophisticated data analytics by designing, developing, and deploying quantitative models and other analytics tools. Working with a multi-disciplinary team of Data Engineers, Data Architects, BI Developers, and operational SME’s across VCU Health, the AI Engineer III will work on complex business problems and provide actionable insights with the overarching goal of improving clinical and financial outcomes. Qualifications - Required: Bachelor’s Degree in Business, IT, Math, Data Analytics, Engineering, or related discipline - Preferred: Master’s degree in Business, IT, Math, Data Analytics, Engineering or related discipline Requirements - 8+ years’ experience in Machine Learning/Artificial Intelligence tools and technologies required - 5+ years’ experience in Python or R and SQL required - 2+ years of experience as a Full Stack Machine Learning Engineer or similar role required - 2+ years’ experience in healthcare environment preferred - Experience working with unstructured data, NLP technologies, and big data is required - Experience working with one of the open-source ML libraries/frameworks - PyTorch/TensorFlow/Keras/Numpy required - Experience with Foundation models, Prompt Engineering, fine-tuning or RAG required - Experience working with Cloud technologies such as AWS/Azure/GCP required Benefits - Mentor and guide junior members of the team sharing expertise in AI/ML techniques, model development, and deployment best practices - Design and implement RESTful APIs to integrate ML models or GenAI solutions with other applications and systems within the organization - Stay abreast of the latest advancements in AI and Machine Learning technologies to ensure VCU Health is in the forefront of AI innovation - Conduct rigorous model evaluation, including performance testing and bias assessment, to ensure the ethical and reliable deployment of AI systems

Role Description At VCU Health, our Epic EHR is a critical platform for delivering high-quality patient care, advancing research, and supporting operational excellence — and analytics is how we turn that data into action. We’re seeking an experienced Epic Cogito Developer II to design and deliver Epic-based reporting and analytics that leaders, clinicians, and teams rely on every day. This role is ideal for someone who enjoys working deep in Epic data, partnering closely with clinical and business stakeholders, and building trusted insights that make a real impact across an academic health system. The Epic Cogito Developer II is responsible for designing, developing, and maintaining the Epic Cogito solutions that help the organization make data-driven decisions. This role requires strong analytical skills, strong proficiency in Epic’s Cogito tools, and the ability to translate business requirements into technical solutions as well as to lead projects involving cross-functional teams. - Participates in the design, development and maintenance of Cogito analytics solutions that transform data into insights through Reporting Workbench reports, Radar dashboards and Slicer Dicer self-service reporting capabilities. - Performs analysis including reviewing multiple data sets and data relationships to support research and business decisions. - Works in concert with application and business teams to understand business requirements and translating those requirements into developing value-add Epic driven solutions. - Develops and enforces implementation of standards and best practices involved in Epic Cogito solutions development and delivery. - Works with Data Engineering team by identifying opportunities to expand data sets and business intelligence tools to include additional data. - Assists with data lineage and coding to support this function. - Supports the data through its life cycle utilizing data governance principles that ensure data quality, integrity, stewardship, security, literacy and adoption. - Provides Technical Support and training to end users on BI tools and reports. - Mentors junior Epic Cogito Developers. Qualifications - Bachelor’s Degree in Business, IT, Math, Data Analytics, Engineering, or related discipline (Required) - Master’s degree in Business, IT, Math, Data Analytics, Engineering or related discipline (Preferred) - Epic Certification(s) and obtain Epic Cogito Certification (within 6 months of hire, 3 chances for exam) (Required) - Epic Cogito Certification (Preferred) Requirements - 5+ years using EHR Reporting tools. - 4+ years of experience with Data Lake, EDW and operational databases required. - 2+ years SQL experience. - Intermediate level knowledge EHR Reporting tools. - Strong problem-solving and analytical abilities. - Intermediate SQL skills. - Understanding data warehousing concepts and practices for managing large datasets. - Strong interpersonal skills and ability to work cross-functionally. - Ability to effectively communicate with technical and non-technical personas and make complex ideas understood. - Ability to understand the long-term ("big picture") and short-term perspectives of situations. - Ability to comprehend quickly the functions and capabilities of new technologies. Benefits - Combination of education and experience in lieu of a degree. - Displays intellectual curiosity and integrity.

• Consults, advises, leads and assists practice management in providing leadership and direction by performing financial and productivity reporting, clinical effort and compensation alignment, budget development and monitoring. • Fulfills service level assistance to assigned MCVP clinical departments to facilitate health system wide alignment. • Ensures compliance with VCU and VCUHS policies and procedures. • Works closely and in collaboration with MCVP Clinical Departments, physicians, advanced practice providers, staff, and management to resolve issues. • Maintains current knowledge of all state and federal laws and regulations and health system policies and procedures.

• Provides solutions to a variety of basic technical problems requiring analysis of multiple factors • Responsible for analyzing, implementing, modifying, and installing low-complex system build in different operational environments • Learns operational and technical workflows • Creates technical specifications, testing plans, and other documentation as defined • Assists with testing and supporting system upgrades and improvements • Understands and performs basic impact analysis functions and remediation • Performs troubleshooting efforts on application issues, submits service requests to vendors, and follows basic correction steps • Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS

• Manages or performs work associated with analysis, design, implementation, operation, deployment, and support of the organization’s information technology resources • Provides solutions to a variety of complex technical problems of diverse scope, requiring analysis and evaluation of multiple factors • Designs and performs system build to meet customer needs • Collects and analyzes information from system users, formulates the scope and objectives of the system procedures, and conducts feasibility studies to design possible system solutions • Writes system and configuration specifications that meet user needs upon implementation • Prepares and maintains technical documentation to guide system users and assists with ongoing operation, maintenance, and system development • Performs impact assessment and ensures remediation is accomplished • Utilizes Senior team members for validation • Performs troubleshooting efforts on application issues • Assists with designing, recommending solutions, testing, and supporting system upgrades and improvements • Leads design sessions with other end-users and/or cross functional teams

Remote: In the state of Virginia ONLY! The Patient Financial Clearance Representative Senior demonstrates strong customer service orientation while handling all business functions in an assigned area to secure the appropriate patient information; ensure that registration data is correct and accurate; validate insurance eligibility, enter information into appropriate systems, collects co-pay (if applicable), and assist with financial counseling and financial clearance, as necessary. This role performs all aspects of the Patient Financial Clearance rep position as needed. In addition, the Patient Financial Clearance Representative Sr. provides real time training when there are new representatives, providing troubleshooting guidance and mentorship. Essential Job functions: - Communicates effectively with patients, clinical staff, and providers when the postponement of services is necessary due to lack of eligibility or benefits. - Prioritizes and coordinates patient accounts that require completion of patient demographic, third party payer and visit data prior to the appointment date. Independently resolves missing or incorrect data elements, specifically for defined critical data set. - Applies additions and revisions to patient’s EPIC account utilizing established registration policies and procedures. - Determines appropriateness of applying plan additions or revisions to past and future scheduled visits and takes appropriate action. - Contacts patient or guarantor by phone, portal, email, or mail and communicates in a professional and courteous manner as necessary to complete or update demographic, third party payer or visit data. - Uses knowledge and accuracy in updating registration data according to established policies and procedures by consistently achieving an accuracy rate of 97% or greater on the EPIC Registration Audit Program - Confirms eligibility and benefits of current health plan for assigned patients prior to scheduled outpatient visit date. - Utilizes combination of on-line eligibility tool, health plan web-based sites, and telephone confirmation with health plan representative to determine current eligibility and benefits. - If eligibility or benefit confirmation is unsuccessful after exhausting all available methodologies, contacts patient or guarantor by phone, email, or portal to communicate eligibility and benefit limitations and/or obtain new health plan data. - May require ability to cancel or reschedule appointments when additional time is needed to confirm health plan eligibility and/or benefits to guarantee payment. - Provides coaching and supports the development and acquisition of job-specific skills - Ensures responsibility and visible commitment to diversity, equity, and inclusion programs/initiatives through collaboration and implementation of initiatives across the health system. - Perform other duties as assigned and/or participates in special projects in order to support the mission of VCUHS and the Department. Patient Population: Not applicable to this position. Employment Qualifications: Required Education: High School Diploma or equivalent Preferred Education: N/A Licensure/Certification Required: N/A Licensure/Certification Preferred: N/A Minimum Qualifications: Required Qualifications: Minimum three (3) years of previous experience in a health care setting to include: Experience in commercial, managed care and governmental health insurance plans and One (1) year experience in insurance plan authorization and referral requirements; or medical billing Other Knowledge, Skills and Abilities Required: Previous experience using a personal computer and various software applications, including Microsoft, e-mail, etc. Strong customer service skills and patients/customers centered focus in a positive manner in all situations. Cultural Responsiveness: Demonstrates a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias. Other Knowledge, Skills and Abilities Preferred: Use of Patient Registration or other medical billing/registration systems, ICD and CPT coding, medical terminology Working Conditions: General office environment. Prolonged periods of working alone. Physical Requirements: Physical Demands: Lifting/ Carrying (0-50 lbs) Work Position: Sitting, Walking, Standing Additional Physical Requirements/ Hazards: Physical Requirements: Repetitive hand arm/hand movements Mental/Sensory - Emotional: Mental/Sensory: Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical Thinking Emotional: Steady-paced environment, Frequent and intense customer interactions, Able to adapt to frequent change Days EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.

The Patient Fin Clearance Rep is responsible for the entire scope of financial clearance activities for assigned patients before the scheduled appointment date. Financial clearance includes, but is not limited to, confirming completeness of patient registration data, verifying insurance eligibility, confirming health plan benefits, procuring PCP referrals and health plan authorizations, calculating/ collecting patient liability estimate, restricting/redirecting out of network patient, and communicating patient financial responsibility. The Patient Fin Clearance Rep ensures patient financial responsibility is communicated with consistency, clarity and transparency to ensure patients understand the cost of services they receive, their insurance coverage and limitations, and their individual responsibility. Successful performance of job duties directly impacts health system goals of streamlining clinical operation work flows as well as improving revenue cycle operations and financial performance. Licensure, Certification, or Registration Requirements for Hire: N/A Licensure, Certification, or Registration Requirements for continued employment: N/A Experience REQUIRED: Minimum three (3) years of previous experience in a health care setting to include: Experience in commercial, managed care and governmental health insurance plans and One (1) year experience in insurance plan authorization and referral requirements; or Medical billing Previous experience using a personal computer and various software applications, including Microsoft, e-mail, etc. Strong customer service skills and patients/customers centered focus in a positive manner in all situations Experience PREFERRED: Previous experience using GE-IDX Patient Registration or other medical billing/registration system Previous experience in ICD and CPT coding Previous experience using medical terminology Education/training REQUIRED: High School Diploma or equivalent Education/training PREFERRED: Post high school education in healthcare or medical billing coursework Independent action(s) required: Collects and updates patient demographic and insurance plan information Verifies insurance plan eligibility and benefits using multiple system and web-based tools, as well as calling payer and patient as necessary Calculates out-of-pocket liability and collects required deposits, co-pays, deductibles and outstanding balances from patient prior to service Refers patients to financial counselors when assistance needed to identify alternate payer source or establish payment plan Contacts in-house and community primary care physicians to secure PCP referral for consult and treatment as required by health plan Contacts health plan to secure prior authorization for procedures/testing as required by health plan Coordinates peer-to-peer review between VCUHS physicians and health plan medical directors to secure prior authorization for services Prepares all forms required to obtain payment from third party payer for services Determines when appropriate to apply additions/revisions to patient account and current visit Maintains thorough knowledge of commercial, managed care and governmental health care plans Maintains thorough knowledge of insurance plan authorization and referral requirements Supervisory responsibilities (if applicable): N/A Additional position requirements: May require work hours to periodically extend to 8:00 p.m. as necessary to resolve backlog or to contact patients for registration data. Age Specific groups served: All Physical Requirements (includes use of assistance devices as appropriate): Physical - Lifting 20-50 lbs. Activities: Prolonged sitting, Reaching (overhead, extensive, repetitive), Repetitive motion, Other: Prolong PC/keyboard usage Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking, Other: Concentrate/Focus Emotional: Fast pace environment, Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Noisy environment, Able to adapt to frequent change EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.