WVU Medicine

Nurse

• Deliver nursing care using the nursing process
• Maintain authority, responsibility, and shift accountability for nursing care delivery
• Provide professional nursing care for patients in an inpatient hospital setting
• Prioritize patient diagnoses, problems, issues, and mutual goals
• Serve as a resource for patient and family learning needs
• Coordinate with interprofessional teams to manage changing priorities
• Provide safe, quality, patient-centered care as an independent team member
• Mentor colleagues in clinical knowledge, skills, abilities, and judgment
• Develop and continuously improve patient care planning systems
• Lead interprofessional collaboration and consultation
• Design innovations to improve patient outcomes
• Assist nurses in developing research skills
• Participate in healthcare planning, policy development, implementation, review, and adherence
• Advocate for healthcare consumers' rights and self-determination
• Engage patients and interprofessional team members in holistic, culturally sensitive data collection
• Integrate global and environmental factors into assessments
• Identify resources for cultural situations and ethical dilemmas
• Recognize personal bias and disseminate educational findings to colleagues
• Pursue higher education and training
• Complete annual specialty-accreditation education when applicable
• Work in all oriented service lines within Fairmont Medical Center Surgical Services
• Complete training/orientation, potentially at Ruby Memorial

Registered Nurse, Fairmont Surgical Services

Claims Specialist

• Manage patient account balances through accurate claim submission, regulatory compliance, timely follow-up, and denial management
• Provide customer support and resolve issues from customer inquiries
• Complete reports and clerical duties as needed
• Submit accurate and timely claims to third-party payers
• Resolve claim edits and account errors before claim submission
• Follow up with third-party payers to support collections and department goals
• Gather statistics and complete reports
• Organize and prioritize daily tasks for productivity, accountability, and efficiency
• Comply with HIPAA regulations and Notices of Privacy Practices
• Contact third-party payers to resolve unpaid claims
• Use payer portals and websites to verify claim status and conduct account follow-up
• Assist Patient Access and Care Management with denial investigation and resolution
• Attend department meetings, teleconferences, and webcasts as needed
• Research and process returned mail and payer-rejected claims
• Reconcile billing account transactions and process billing and follow-up transactions
• Maintain knowledge of federal, state, and local hospital-billing regulations
• Monitor accounts to facilitate timely follow-up and maximize cash receipts
• Maintain work queue volumes and productivity within established guidelines
• Provide customer service to patients, visitors, and employees
• Participate in performance improvement initiatives
• Develop and exceed annual goals with supervisor and manager
• Maintain confidentiality of demographic, clinical, and financial information
• Communicate workflow problems to management promptly

Insurance Claims Specialist

Analyst

• Support Pharmacy Department operational efficiency through fiscal management activities, data analysis, and departmental statistics and reports
• Develop databases and manage projects using cost accounting and IT skills
• Assure accurate and timely departmental billing procedures
• Coordinate accounting and financial processes, internal controls, and System-wide accounting functions
• Lead and coordinate 340B entities’ split billing, contract pharmacy tracking, variances, savings, forecasts, and financial reporting
• Review medication purchases, revenue, contract pharmacy fees, pricing, compliance, budgets, expenses, and savings opportunities
• Generate budget, reconciliation, pharmacy spend advisor, cost savings, and year-end reports
• Provide data supporting performance improvement in drug utilization, purchasing, billing, and reimbursement
• Reconcile expenditures with the hospital general ledger and rectify errors
• Identify irregular spending and system failures and report findings to department leadership
• Collaborate with hospital departments, pharmacy management, system pharmacy leadership, GPOs, and wholesalers
• Educate 340B professionals on Split Billing, Split Matching, and Contract Pharmacy relationships
• Maintain financial records, policies, procedures, safeguards, and system integrity
• Monitor ordering, wholesaler pricing, invoices, shipping, and inventory processes
• Participate in departmental goals, change initiatives, meetings, committees, task forces, and projects

Pharmacy Analyst – 340B

Supervisor

• Manage day-to-day operations of Information Technology staff, including workload, payroll, career growth, performance reviews, timecards, vacation, and on-call schedules
• Lead professional development, onboarding, training, mentoring, and team building
• Coordinate design, development, testing, implementation, upgrades, and maintenance of new and legacy systems
• Lead customer collaboration to identify system solutions, streamline operations, and ensure patient safety and confidentiality
• Oversee production issues, escalation, complex test scripts, testing, documentation, outages, and system performance restoration
• Evaluate and document operational performance, incidents, service requests, and problem resolutions for complex systems
• Use reporting workbench, report writers, Chronicle, SQL, advanced Excel macros, and specialized analysis and reporting tools
• Coordinate projects, resource allocation, work estimates, milestones, vendor calls, status reports, upgrades, and test plans
• Develop processes and procedures, improve turnaround times, lead team meetings, and escalate issues to the Manager
• Facilitate training programs and support strategic planning and system training environments
• Perform or oversee complex system analyses, design, simulation, and system process or data structure changes
• Manage applications support and deployment across HR, ER, business, clinical, PACS, EMR/EPIC, cardiology, laboratory, and pharmacy environments
• Oversee backend hardware, Unix/Linux, storage, server, virtualization, security-control, SIEM, financial, web, and Epic ancillary services teams
• Manage analytics initiatives, data governance, data quality, data models, pipelines, reporting structures, and delivery of concurrent projects
• Ensure customer satisfaction and adherence to WVUHS and entity policies

Supervisor – Epic Cogito Analytics

Full-stack Engineer

• Oversee end-to-end encounters data management, including ingestion, cleansing, transformation, and integration
• Develop and implement best practices for encounters data processing
• Establish data integration processes with internal and external stakeholders
• Coordinate with IT teams and vendors to ensure accurate data exchange between systems and platforms
• Design, develop, and optimize encounter data models
• Monitor encounters data process performance and implement optimization measures
• Provide technical expertise and guidance in encounters data management and analysis
• Set technical objectives and expectations and lead delivery of high-quality solutions
• Collaborate across teams, prioritize demands, synthesize information, and generate meaningful conclusions
• Develop and implement team training programs
• Implement quality assurance processes and conduct regular audits for data accuracy and integrity
• Identify and resolve data-related issues with cross-functional teams
• Use advanced analytics to extract insights from encounter data
• Support analytics teams with data requirements, analytical models, and reports
• Ensure compliance with regulatory requirements, guidelines, and contractual obligations for CMS encounter submissions and response files
• Work on a computer in a remote environment

Encounters Technical Lead

• Assess, design, develop, and evaluate nursing, clinical, training, professional development, and special training programs
• Ensure competency and education across all clinical areas
• Provide internal consultation to management and work groups regarding clinical education
• Develop, coordinate, and evaluate onboarding and orientation for clinical staff
• Identify orientation requirements for clinical staff
• Manage and evaluate the competency assessment process with management teams
• Support professional role development
• Execute special projects requested by the CED Leadership Team
• Promote research, evidence-based practice, and quality improvement in educational settings
• Teach, coordinate, serve as liaison, and advise nurses and other learners
• Collaborate with interprofessional teams, nursing officers, directors, managers, and stakeholders to facilitate nursing practice and positive outcomes
• Conduct learning needs assessments and disseminate findings
• Recommend educational strategies supporting regulatory and accrediting requirements
• Develop and maintain educational materials and programs using adult learning principles
• Serve as a nurse planner in continuing education activities
• Maintain AHA instructor status and participate in AHA training
• Consider safety, effectiveness, and cost in clinical professional development activities

Nurse Educator – Hybrid Remote

General

• Perform preoperative, intraoperative, and postoperative support activities for surgical/procedural patients
• Provide total care within scope of practice, including monitoring stable vital signs, activities of daily living, and comfort
• Perform point-of-care tests and report patient-condition changes to an RN
• Assist with supplies, instruments, and equipment for surgical/procedural cases
• Open sterile supplies using aseptic technique, perform shave preps, and hold extremities during preps
• Clean and prepare work areas, transport patients, assist with transfers and positioning
• Retrieve and clean patient-care equipment and run errands
• Maintain stocking, inventory control, supply carts, instruments, and equipment
• Clean and sanitize procedural areas, sterile processing areas, patient bays, equipment, and autoclaves
• Process instruments and scopes, prepare decontamination solutions, and operate cleaning and sterilization equipment
• Wrap and label instruments and supplies for sterilization; prepare OR linen and sterile packs as assigned
• Record patient weights, temperatures, pulses, respirations, blood pressures, intakes/outputs, and abdominal girths as directed
• Transport specimens, document delivery, and add fixative when needed
• Set up oxygen equipment, change tank regulators, and check tank volumes
• Report equipment and room repairs, tag equipment, and submit Biomed tickets
• Relay telephone, visitor, patient, and healthcare-provider messages
• Transport linens, trash, biohazardous materials, and case carts using PPE and required signage
• Assist with room and bay setup and monitor sterile-field setup when directed by an RN
• Perform telephone answering and minor clerical duties
• Transport non-narcotic medications and patients with PCA/Epidural pumps when directed
• Rotate through Fairmont Surgical Services areas including Pre-op, OR, and PACU; complete training and orientation at Ruby Memorial

Perioperative Care Specialist

Intake Specialist

• Coordinate intake for new patient referrals, including receiving referral information, insurance verification, and scheduling initial assessments.
• Serve as the primary contact for patients, families, referral sources, and healthcare professionals regarding referral and authorization status.
• Obtain and document initial and ongoing authorization numbers using EPIC or other electronic systems.
• Maintain accurate precertification, authorization, and referral communication documentation.
• Communicate with insurance companies to obtain prior authorization and resolve authorization-related issues.
• Monitor authorization status and certification deadlines, including proper sequencing of payors for billing.
• Enter and maintain patient referral and insurance information in appropriate systems.
• Coordinate initial assessment scheduling with clinical staff.
• Apply CPT and HCPC coding knowledge to precertify and authorize home health/hospice referrals.
• Assist with denial management, audits, and documentation requests.
• Track referral activity and ensure timely processing to support admission and billing.
• Communicate with internal departments regarding authorization status and referral progress.
• Meet productivity, throughput, turnaround-time, and deadline expectations.
• Provide exceptional customer service to patients, families, referral sources, and care teams.

Intake and Precertification Specialist – Home Health and Hospice

• Coordinate intake for new patient referrals, including receiving referral information, insurance verification, and scheduling initial assessments
• Serve as the primary contact for patients, families, referral sources, and healthcare professionals regarding referral and authorization status
• Obtain and document initial and ongoing authorization numbers using EPIC or other electronic systems
• Maintain accurate precertification, authorization, referral, and communication documentation
• Communicate with insurance companies to obtain prior authorization and resolve related issues
• Monitor authorization status, certifications, recertifications, and payer sequencing for billing
• Enter and maintain patient referral and insurance information in appropriate systems
• Coordinate initial assessment scheduling with clinical staff
• Maintain current knowledge of CPT and HCPCS coding to precertify/authorize home health and hospice referrals
• Assist with denial management, audits, and documentation requests
• Track referral activity and ensure timely processing to support admission and billing
• Communicate authorization status and referral progress to internal departments
• Meet productivity, throughput, turnaround-time, and deadline expectations in a high-volume referral environment
• Provide exceptional customer service to patients, families, referral sources, and care teams

Intake and Precertification Specialist, Home Health and Hospice

Physician

• Provide emergency medicine physician services for WVU Health System hospital locations
• Care for patients at critical access hospitals, community sites, regional medical centers, or academic medical centers as applicable
• Complete the application in full to be considered

Emergency Medicine Physician

Human Resources

• Maintain positive and effective employee/labor relations practices
• Implement and oversee HR policies and procedures
• Develop, coordinate, and maintain HR policies, programs, and training focused on employee/labor relations
• Advise hospital and management staff on employee and labor relations issues
• Develop and recommend employee relations practices that support positive working relationships and employee morale
• Assist with arbitrations and other legal inquiries
• Interpret collective bargaining agreements and support organizational compliance
• Communicate policies, values, and state and federal laws to hospital staff and management
• Investigate harassment, working conditions, disciplinary, appeal, and grievance issues
• Advise and assist management with counseling, discipline, and termination decisions
• Review written corrective action forms in Human Resources
• Assist management with grievance procedures and review grievance statements and responses
• Attend third-level grievance meetings
• Develop processes and tools supporting employee and labor relations
• Work with an outside vendor on unemployment claims

Associate Employee & Labor Relations Consultant

• Review and oversee adjudication of Medicare insurance claims ranging from simple data entry to complex specialty claim research
• Analyze and process insurance claims, checking validity in accordance with all CMS guidelines
• Screen, review, evaluate online entry, correct errors, and perform quality control for final adjudication of paper/electronic claims
• Ensure accuracy of data entered and maintain records
• Analyze claims to determine the extent of insurance carrier liability
• Resolve claim edits, review history records, and determine benefit eligibility for services
• Review payment levels and arrive at final payment determinations
• Interpret contract benefits and adjudicate claims according to Medicare claims processing guidelines
• Meet production and quality standards and maintain work queues according to department standards
• Communicate effectively with internal and external colleagues
• Elevate issues to the next level of supervision as appropriate
• Attend required training classes and demonstrate proficiency and ability to learn
• Read and interpret explanations of benefits (EOBs)
• Provide mentorship to less experienced staff as assigned by leadership
• Maintain patient/member confidentiality according to PHI and HIPAA guidelines

Medicare Claims Processor

Insurance

• Obtain authorizations for elective infusions and injections to financially clear patients and ensure reimbursement
• Use payor resources and medical policies to verify prior authorization requirements
• Escalate financial clearance risks in compliance with the Financial Clearance Program
• Liaise between clinical teams and pharmacists regarding infusion prior authorization issues
• Code cases and review clinical documentation for completeness and maximum reimbursement
• Manage workloads and prioritize deadlines using EPIC work queues
• Collect and communicate outpatient benefit information to Patient Financial Services through Epic queues and billing indicators
• Refer to medical and coverage policies for medications and research CPT codes for drugs/injections
• Verify and submit authorizations through insurance portals, forms, or calls
• Review medical records to answer clinical authorization questions
• Communicate with clinics when additional information is needed
• Follow up on authorization requests, peer-to-peer reviews, and prior authorization appeals
• Communicate when home infusion or pharmacy benefits are needed
• Verify referrals and authorizations in work queues and identify medication dosing/frequency changes
• Assist with denial management and obtain retro authorizations
• Maintain Epic in baskets and Outlook emails
• Participate in monthly team meetings and one-on-ones
• Build admissions and submit authorizations for elective inpatient chemotherapy admissions and observations
• Follow workflows, report process deficiencies, maintain confidentiality, and communicate respectfully with staff, physicians, patients, families, and the public

Insurance Authorization Specialist III

• Submit accurate and timely claims to third party payers
• Resolve claim edits and account errors before claim submission
• Follow up with third party payers to ensure collections and exceed department goals
• Gather statistics, complete reports, and perform scheduled or requested duties
• Organize and prioritize daily tasks for productivity, accountability, and efficiency
• Comply with Notices of Privacy Practices and HIPAA regulations concerning PHI and claim submission/follow-up
• Contact third party payers to resolve unpaid claims
• Use payer portals and websites to verify claim status and conduct account follow-up
• Assist Patient Access and Care Management with denial investigation and resolution
• Attend educational programs, department meetings, teleconferences, and webcasts as necessary
• Research and process returned mail and payer-rejected claims
• Reconcile billing account transactions and process billing and follow-up transactions accurately and timely
• Maintain knowledge of federal, state, and local hospital billing regulations
• Monitor accounts to facilitate timely follow-up and payment and maximize cash receipts
• Maintain work queue volumes and productivity within established guidelines
• Provide customer service to patients, visitors, and employees
• Work with supervisors and managers to develop and exceed annual goals
• Maintain confidentiality regarding demographic, clinical, and financial information
• Communicate workflow problems to management in a timely manner

Customer Support

• Accurately post data, including payments and adjustments
• Communicate workflow problems to management
• Resolve patient billing and third-party payer concerns
• Interview and counsel patients regarding payment arrangements, charity assistance, and other assigned matters
• Answer patient questions quickly, accurately, and courteously
• Identify and screen Medicare charity within established guidelines
• Rebill accounts as necessary
• Work with patients to resolve account balances
• Perform frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling throughout the work shift
• Work in a normal business office environment with high stress and constant interruptions

Registered Nurse, Fairmont Surgical Services

Insurance Claims Specialist

Pharmacy Analyst – 340B

Supervisor – Epic Cogito Analytics

Encounters Technical Lead

Nurse Educator – Hybrid Remote

Perioperative Care Specialist

Intake and Precertification Specialist – Home Health and Hospice

Intake and Precertification Specialist, Home Health and Hospice

Emergency Medicine Physician

Associate Employee & Labor Relations Consultant

Medicare Claims Processor

Insurance Authorization Specialist III

Insurance Claims Specialist

Customer Service Representative