The Utilization Review RN evaluates medical records to determine medical necessity and patient status to optimize reimbursement. They collaborate with interdisciplinary teams and payors to manage concurrent denials and ensure adherence to regulatory requirements.
The strategist will lead efforts to design and implement pharmacy business solutions while managing cross-functional relationships to improve systems and productivity. They are responsible for performing complex data analysis, maintaining database integrity, and providing actionable insights to drive strategic business decisions.
The Pharmacy Analyst supports operational efficiency by coordinating fiscal management, performing data analysis, and maintaining departmental statistics. They are responsible for managing 340B program compliance, tracking financial variances, and generating reports to optimize pharmacy purchasing and billing.
This position performs a wide range of accounting functions to support the month-end financial statement process and budget preparation for WVU Medicine. Responsibilities include reconciling invoices, managing capital payroll, preparing journal entries, and assisting with external audits.
The Senior Accountant performs financial functions including departmental analysis, reconciliations, and billing to support the budget process. They also oversee accounting staff, maintain the general ledger, and coordinate month-end variance analysis.
The Medical Dosimetrist is responsible for generating radiation therapy treatment plans by utilizing clinical knowledge of oncology, physics, and anatomy. They must communicate these plans effectively to the radiation oncologist and radiation therapist while ensuring high accuracy and safety standards.
Responsible for managing patient account balances, including accurate claim submission and compliance with billing regulations. Supports revenue cycle operations by performing follow-ups, resolving claim errors, and assisting with denial management.
The scheduler is responsible for managing outpatient visits, including scheduling, rescheduling, and registering patients for multiple ambulatory clinics. They must also verify patient information, coordinate with referring physicians, and ensure all necessary medical orders are documented.
The Centralized Scheduler is responsible for managing outpatient visit scheduling, cancellations, and registrations for multiple ambulatory clinics. They must collect necessary patient information, verify insurance/guarantor details, and coordinate with referring physicians to ensure accurate medical documentation.
The Intake Specialist manages the referral process, including insurance verification, patient assessments, and scheduling initial care. They collaborate with interdisciplinary teams to develop care plans and ensure seamless transitions for patients entering home health or hospice services.
The physician will provide high-quality patient care in a family medicine setting while actively participating in the education of medical students, residents, and fellows. The role involves clinical practice with support from subspecialty areas and administrative tools like scribe support and Epic EMR.
The Utilization Review RN performs initial and concurrent reviews of medical records to ensure medical necessity and optimize reimbursement. They collaborate with interdisciplinary teams and payors to manage denials and facilitate appropriate patient status.
The Lead Utilization Management Coordinator oversees concurrent denial mitigation, manages authorization processes, and ensures institutional reimbursement optimization. This role also provides clinical leadership, mentors staff, and collaborates with physician advisors to improve operational integrity and denial prevention.
The specialist is responsible for accurately assigning ICD-10 and CPT codes to inpatient and outpatient medical records to ensure proper reimbursement and compliance. They also perform audits, provide provider education, and resolve billing issues to maintain high standards of coding accuracy.
The Centralized Scheduler is responsible for managing outpatient visit scheduling, registration, and patient check-in/check-out processes across multiple ambulatory clinics. They also handle financial collections, insurance verification, and coordination of follow-up testing and appointments.
The position is responsible for scheduling patient procedures, managing pre-registration, and verifying medical insurance information. It also involves maintaining effective working relationships with physician office staff and providing high-quality customer service.
The specialist is responsible for accurately posting insurance and patient payments to the Epic system while balancing bank deposits. They also research and resolve unidentified payments, manage refund requests, and reconcile accounts to ensure financial accuracy.
The Accounts Payable Specialist manages payment cycle activities, processes and reconciles invoices, and ensures accurate financial recordkeeping. They also maintain vendor records, audit transactions for policy compliance, and provide customer service regarding payment inquiries.
The role is responsible for collecting and submitting reliable clinical data to national quality databases to support performance improvement initiatives. It involves collaborating with hospital departments to analyze data, identify process improvements, and serve as an educational resource for internal and external audiences.
The Patient Navigator manages patients through the healthcare system by serving as a primary point of contact and coordinating care, appointments, and resources. They also analyze market data to assist with payer population strategies and ensure insurance coverage for treatments.
The Insurance Claims Specialist is responsible for managing patient account balances, including accurate claim submission and timely follow-up with third-party payers. They also assist with denial management and ensure compliance with all federal, state, and internal billing regulations to maintain financial viability.
The Nurse Navigator is responsible for clinically triaging patient referrals and facilitating multidisciplinary care across the continuum. They provide patient education, coordinate appointments, and serve as a primary liaison between patients and clinical providers.
The role involves reviewing medical record documentation to accurately assign ICD-10 and CPT codes for outpatient encounters. The specialist ensures compliance with coding guidelines and collaborates with physicians to obtain necessary information for accurate billing.
The manager leads a team providing financial and compliance analyses to support organizational leaders in outpatient services. They are responsible for ensuring regulatory compliance, optimizing reimbursement, and managing staff development and reporting processes.
The role involves developing and maintaining collaborative relationships with healthcare providers to ensure high-quality outcomes and patient satisfaction. The incumbent will educate providers on policies, procedures, and regulatory updates while managing network landscape data.
The CDI Specialist III is responsible for the strategic management of service line integration and performing high-level clinical documentation reviews. They also assist the manager with department planning, data reporting, and mentoring junior staff to ensure accurate DRG assignment and quality outcomes.
The specialist is responsible for accurately interpreting medical record documentation to assign appropriate ICD-10 and CPT codes for inpatient and outpatient encounters. They also monitor provider documentation, perform audits, and collaborate with clinical staff to ensure accurate billing and compliance.
The Project Manager leads and coordinates provider-based department projects to ensure operational sustainability and performance. They act as a primary liaison between stakeholders to implement strategic initiatives and ensure compliance with regulatory requirements.
The specialist is responsible for reviewing complex surgical documentation to assign accurate ICD-10, CPT, and HCPCS codes in compliance with national guidelines. They also collaborate with providers to resolve documentation insufficiencies and support revenue cycle operations to ensure accurate billing.
The specialist is responsible for accurately coding inpatient and outpatient medical records using ICD-10 and CPT guidelines to ensure proper reimbursement and compliance. They also perform audits on provider documentation and collaborate with clinical staff to resolve billing issues and improve coding accuracy.
The lead specialist monitors and coordinates coding work assignments while performing audits to ensure compliance and optimum reimbursement. They also provide training, resolve billing issues, and collaborate with revenue cycle teams to maintain accurate medical documentation.
The Disease Management Coordinator collaborates with patients and providers to optimize health status through effective care coordination and utilization management. They are responsible for risk stratifying populations, implementing individualized care plans, and facilitating safe transitions of care across the healthcare continuum.
The Enrollment Analyst manages member enrollment applications, processes Medicare and ACA transactions, and ensures compliance with CMS regulations. They also perform data reconciliation, maintain member records, and develop training programs for the enrollment team.
The Workday System Architect designs, implements, and optimizes architecture strategies to meet enterprise business needs. They provide strategic consultation, lead complex system designs, and oversee change management processes to ensure business solutions are effective and scalable.
The Clinical Appeals Coordinator investigates and processes medical necessity appeals for members and providers while ensuring compliance with regulatory standards. They serve as a subject matter expert, documenting case information and generating formal responses for the medical management team.
The Business Optimization Strategist designs and implements solutions to improve organizational systems and processes while serving as a primary contact for data analytics. They manage cross-functional project teams, perform complex data analysis, and provide actionable insights to support strategic business decisions.
The technician is responsible for securing patient data, performing insurance verification, and assisting pharmacists with prescription filling and labeling. They also conduct patient interviews to gather clinical and financial information while ensuring compliance with departmental policies.
The specialist is responsible for accurately assigning ICD-10 and CPT codes to inpatient and outpatient medical records to ensure proper reimbursement and compliance. They also perform audits on provider documentation and collaborate with clinical staff to resolve billing issues and missing charges.
The role involves reviewing medical record documentation to assign accurate ICD-10 and CPT codes for outpatient encounters. It also requires ensuring timely coding, charging, and abstraction of accounts to facilitate accurate billing and compliance.
The Enrollment Analyst will process and oversee member enrollment applications for Medicare and ACA plans, ensuring data accuracy and compliance with CMS regulations. They will also manage reconciliation processes, resolve enrollment discrepancies, and develop training programs for the enrollment team.
The AI Literacy Specialist drives organizational understanding of AI by developing training programs, educational resources, and learning pathways. They facilitate workshops, provide end-user support, and ensure responsible AI adoption in alignment with governance and security requirements.
The Nurse Navigator is responsible for triaging patient referrals, assessing clinical needs, and facilitating care across the multidisciplinary continuum. They provide patient education, coordinate appointments, and serve as a primary communication link between patients and healthcare providers.
The technician assists in drug distribution, medication preparation, and inventory management under the supervision of a pharmacist. They also communicate with patients regarding medication delivery and maintain accurate records for controlled substances.
The specialist coordinates the implementation and deployment of Epic AI products across clinical and operational areas. They also partner with cross-functional teams to gather requirements, design workflows, and monitor the adoption and impact of AI solutions.
The technician assists in drug distribution, prepares unit-dose and non-intravenous medications, and manages inventory under pharmacist supervision. They also communicate with patients regarding medication delivery and ensure pharmacy areas remain clean and organized.
The Disease Management Coordinator collaborates with patients and providers to optimize health status through effective care coordination and utilization management. They identify target populations, implement individualized care plans, and monitor clinical and financial outcomes to ensure quality healthcare delivery.
The specialist is responsible for managing patient account balances, including accurate claim submission, compliance with billing regulations, and timely follow-up. They also assist with denial management and serve as a resource for team members to ensure efficient revenue cycle operations.
This position is responsible for obtaining prior authorizations for elective infusions and injections to ensure financial clearance and reimbursement. The specialist acts as a liaison between clinical teams and pharmacists while managing work queues and resolving authorization denials.
The specialist will provide high-quality maternal-fetal medicine care, including managing high-risk pregnancies and performing prenatal diagnostics. Additionally, the role involves teaching and mentoring medical students, residents, and fellows within an academic clinical environment.
The specialist will provide high-quality maternal-fetal medicine care, including managing high-risk pregnancies and performing prenatal diagnostics. Additionally, the role involves active participation in teaching and mentoring medical students, residents, and fellows within an academic setting.
The Lead Pharmacist is responsible for overseeing pharmacy operations and ensuring compliance with state board regulations. The role involves managing pharmacy staff and maintaining high standards of clinical service within the medical center.
The Coding Auditor-Educator is responsible for managing quality improvement audits, training coding staff, and ensuring accurate coding and DRG assignment. They act as an expert resource for clinical documentation, revenue cycle operations, and EMR data governance.
The specialist is responsible for reviewing complex surgical documentation to assign accurate ICD-10, CPT, and HCPCS codes while collaborating with clinical staff to resolve documentation insufficiencies. They also monitor provider documentation, perform audits for coding accuracy, and assist in revenue cycle claim development.
The specialist is responsible for accurately coding medical records to ensure compliance, appropriate reimbursement, and correct severity of illness documentation. They also perform audits, provide provider education, and resolve missing charges or problem accounts to facilitate the billing process.
This position is responsible for developing, designing, and conducting training programs for revenue cycle operations and patient access systems. It also involves monitoring quality, administering proficiency tests, and collaborating with IT on system upgrades.
The role involves designing and implementing analytical solutions using Power BI and SQL to drive strategic business decisions. It also requires managing project coordination, gathering requirements, and facilitating process improvements across the organization.
Responsible for accurately assigning ICD-10 and CPT codes for various patient classes to ensure proper reimbursement and compliance. The role involves analyzing medical records, resolving missing charges, and collaborating with providers to improve documentation accuracy.
Responsible for accurately assigning ICD-10 and CPT codes to medical records to ensure proper reimbursement and compliance. The role involves auditing provider documentation and collaborating with physicians to resolve coding and billing issues.
Responsible for accurately coding complex inpatient and interventional radiology medical records to ensure proper reimbursement and compliance. This includes assigning appropriate ICD-10 and CPT codes and ensuring correct MS-DRG assignments.
Responsible for assigning accurate ICD-10 and CPT codes for moderately complex patient classes to ensure proper reimbursement and compliance. This includes reviewing medical records and communicating with physicians to obtain necessary documentation for clean billing.
This role manages the enterprise coding department to ensure financial viability and seamless coding processes across the organization. Responsibilities include leading coding teams, monitoring KPIs, and collaborating with leadership to optimize revenue cycle performance.
The role involves reviewing and interpreting medical record documentation to assign appropriate codes for diagnoses and procedures. It also includes ensuring quality and timely coding and maintaining coding knowledge through continuous education.
Lead the design and delivery of systemwide training programs for CDI, coding, utilization review, and denial management. Develop educational content and provide case-based support to providers to improve documentation accuracy and financial performance.
The physician will practice diagnostic radiology for WVU Medicine Community Hospitals. The role involves providing remote radiology services across West Virginia, Pennsylvania, and Ohio.
Collaborates with multidisciplinary teams to ensure quality pharmacy care, patient safety, and the development of programmatic improvements. Leads research projects in quality and safety while providing education to patients, providers, and students.
Responsible for assigning accurate ICD-10 and CPT codes for various patient classes to ensure proper reimbursement and compliance. The role involves auditing provider documentation and collaborating with physicians to resolve coding and billing issues.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
