Responsible for scheduling, cancelling, and registering outpatient visits and procedures for multiple ambulatory clinics. This includes verifying patient information, managing referrals, and coordinating with referring physician offices.
WVU Medicine
40 Remote Job Openings at WVU Medicine
Collaborates with multidisciplinary teams to ensure quality pharmacy care, patient safety, and adherence to clinical guidelines. Leads research projects and provides education to patients, providers, and students within the health system.
Handle inbound and outbound calls to resolve member inquiries and provide general healthcare information. Collaborate with management and peers to research issues and maintain accurate member documentation.
The SNP Engagement Specialist coordinates care for members by facilitating transitions, scheduling wellness visits, and educating members on supplemental benefits. They act as a primary contact for D-SNP members to ensure engagement and compliance with CMS Model of Care expectations.
The Lead Care Manager provides coordination of care for SNP members by establishing individualized care plans and collaborating with Interdisciplinary Care Teams. They are responsible for ensuring compliance with CMS Model of Care expectations and NCQA standards while managing transitions of care.
The SNP Social Worker coordinates benefits and connects members with community resources while serving as a key member of the interdisciplinary care team. They perform behavioral health assessments and develop individualized care plans for members with complex psychosocial and economic needs.
Manage patient account balances by ensuring accurate claim submission and following up on unpaid claims to maintain financial viability. Resolve claim edits, handle denial investigations, and maintain compliance with federal and state billing regulations.
Responsible for assigning accurate ICD-10 and CPT codes for complex inpatient and interventional radiology records to ensure proper reimbursement and compliance. The role involves reviewing medical documentation and collaborating with physicians to ensure data accuracy and timely billing.
Handle inbound and outbound calls from Medicare Advantage members and providers to resolve complex inquiries. Collaborate with the Peak Health team to research issues and maintain accurate member documentation.
Responsible for the collection, entry, and reporting of trauma center data for regulatory agencies. Utilizes collected data for injury research, epidemiology, and performance improvement initiatives.
The Senior Care Manager is responsible for onboarding, mentoring, and coaching the care management team while performing documentation audits. They also assist in the development of policies, procedures, and educational strategies to improve member health outcomes.
Supervises hospital and professional coding staff to ensure accurate reimbursement, abstracting, and compliance with federal and state regulations. Manages day-to-day operations including personnel management, auditing, and the development of coding policies.
Facilitates the improvement of clinical documentation quality to ensure accurate coding, severity of illness, and risk of mortality. Collaborates with providers to clarify diagnoses and provides ongoing education on documentation guidelines and compliance.
Perform drug utilization reviews for initial determinations and appeals across various lines of business, including Medicare Advantage. Serve as a subject matter expert for pharmacy utilization management and collaborate with medical directors on specialty medication consults.
Responsible for accurately assigning diagnostic and procedure codes to patient records for moderately complex services like ED and same day care. Ensures compliance with national guidelines and maintains productivity and quality standards for reimbursement.
The specialist is responsible for reviewing patient care documentation and conducting audits to ensure compliance with healthcare regulatory standards. They analyze data to identify trends and collaborate with healthcare professionals to improve patient outcomes and care delivery.
The specialist is responsible for reviewing patient care documentation and conducting audits to ensure compliance with healthcare regulatory standards. They will analyze data to identify trends and collaborate with healthcare professionals to enhance care delivery and patient outcomes.
Oversee day-to-day operations of the IT analytics team, including staff development, payroll, and project coordination. Lead the design, implementation, and maintenance of Epic Cogito analytics solutions to improve patient safety and operational efficiency.
Design and implement BI solutions using Power BI, Fabric, and SQL Server to improve business processes and strategic decision-making. Develop complex DAX metrics, semantic models, and optimized SQL queries while ensuring data governance and security.
Design and implement scalable data management and architecture strategies using Microsoft Fabric to align with healthcare business needs. Lead the development of enterprise analytics solutions, ensuring data integrity, security, and compliance with healthcare regulations.
Responsible for preparing, labeling, and delivering unit-dose and non-parenteral medications while maintaining accurate records. Manages pharmacy inventory and communicates with patients or caregivers to coordinate medication delivery and pickup.
Hospital Coding Specialist II - Cancer Center/Infusions
WVU Medicine
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Full Time
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20 days ago
WVU Medicine
Responsible for assigning accurate ICD-10 and CPT codes for moderately complex patient classes to ensure proper reimbursement and compliance. Collaborates with physicians to obtain necessary documentation and ensures the timely completion of clean bills.
Manage accounts receivable related to denied claims by investigating denials and writing non-clinical appeals. Ensure financial viability and compliance with federal and state billing regulations while maintaining productivity standards.
Responsible for assigning accurate ICD-10 and CPT codes for moderately complex patient classes including ED and observation. Ensures compliance, appropriate reimbursement, and timely abstraction of medical records to facilitate clean billing.
Responsible for obtaining authorizations for elective procedures and services to ensure financial clearance for patients. This role involves reviewing clinical documentation, coordinating with insurance payors, and managing denials to minimize organizational write-offs.
Responsible for managing utilization review functions, including communicating clinical information to third-party payors to ensure hospitalization approval. The role involves documenting authorizations, processing denials, and liaising between clinical teams and insurance providers.
The successful candidate will practice as a Tele-Radiologist providing services to WVU Medicine Community Hospitals. Responsibilities include interpreting radiological images remotely across West Virginia, Pennsylvania, and Ohio.
Professional Coding Specialist III - Cardiothoracic Surgery
WVU Medicine
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Full Time
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a month ago
WVU Medicine
Assign accurate ICD-10, CPT, and HCPCS codes for complex surgical procedures, specifically within cardiothoracic surgery. Collaborate with providers to resolve documentation insufficiencies and perform audits to ensure coding accuracy and compliance.
Provide comprehensive medical nutrition therapy to a diverse patient population and document assessments and consults in medical records. Collaborate with medical teams to optimize patient care and supervise nutritional therapy support staff and interns.
Responsible for the accurate coding and abstraction of oncology patient data for clinical trials, research, and national reporting. Duties include case finding, staging, and monitoring patient follow-up activities to maintain accreditation standards.
Supports the design, implementation, and maintenance of software systems to enhance operational efficiency and organizational needs. Responsibilities include system troubleshooting, providing end-user training, and coordinating project milestones and documentation.
The role involves implementing, testing, and maintaining health insurance benefit plans and configurations to ensure regulatory compliance. It also requires analyzing medical billing codes and collaborating with IT to integrate these configurations into technology platforms.
Associate Systems Analyst - MyChart/Digital Experience
WVU Medicine
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Full Time
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a month ago
WVU Medicine
Supports the design, implementation, and maintenance of software systems, specifically focusing on MyChart and digital experience initiatives. Responsibilities include troubleshooting IT issues, providing end-user training, and coordinating projects to improve patient and operational efficiency.
The successful candidate will practice in the area of Radiology as a Tele-Radiologist. Responsibilities include providing diagnostic services to WVU Medicine community hospitals remotely.
This role is responsible for educating and training coding staff, overseeing auditing and education plans, performing quality audits, and providing ongoing feedback. The position also acts as an expert coding resource, manages quality improvement audits, and coordinates external audits.
The successful candidate will practice in the area of Diagnostic Radiology for the WVU Medicine Community Hospitals. This role is fully remote and offers additional earning opportunities.
The role involves leading the design, innovation, and implementation of solutions to improve systems and processes by advocating for customer needs and identifying productivity opportunities. Core duties include maintaining a deep understanding of database structures and BI tools to create analytical solutions, serving as the first point of contact for data analytics, and performing data analysis to ensure accuracy and drive strategic business decisions.
This role is responsible for educating and training coding staff, overseeing auditing and education plans, performing quality audits, and providing ongoing feedback. The position also acts as an expert coding resource, manages quality improvement audits, and coordinates external audits.
The Hospital Coding Specialist III is responsible for coding inpatient and interventional radiology cases, ensuring accurate documentation and compliance with coding guidelines. They must also maintain coding knowledge and communicate with physicians to obtain necessary information for accurate coding assignments.
The Lead Pharmacist will oversee pharmacy operations and ensure compliance with state regulations. They will also provide leadership and management within the pharmacy setting.
