Jobs at WVU Medicine

Manage patient account balances by submitting accurate claims, resolving claim edits and denials, following up with third-party payers, reconciling billing transactions, maintaining productivity, ensuring HIPAA compliance, and providing customer service to maximize cash collections.

Design and build BI solutions and dashboards, perform data analysis and SQL development, apply data governance and security, and lead requirements gathering and project coordination to drive process improvement and reporting accuracy across the health system.

Supports pharmacy financial and operational efficiency through 340B program analysis, accounting coordination, billing validation, budget variance monitoring, reconciliation, forecasting, and reporting. Reviews medication purchases, contract pharmacy activity, pricing, invoices, inventory, and savings opportunities. Maintains financial records, supports audits, identifies irregularities, promotes compliance, and provides recommendations to pharmacy leadership. The role also contributes to performance improvement, policy documentation, system integrity, and education regarding split billing, split matching, and contract pharmacy processes.

Leads pharmacy and 340B business optimization through data analysis, database management, reporting, automation, process improvement, and project coordination. The role gathers requirements, develops analytical solutions and queries, maintains drug utilization and formulary databases, validates reporting accuracy, identifies spending irregularities, and provides insights to support strategic decisions. It also coordinates cross-functional projects, implements system changes, supports pharmacy stakeholders, and collaborates with management, clinical specialists, and vendors.

The Utilization Review RN reviews medical records to determine medical necessity, patient status, and authorization requirements. The role communicates clinical information to payers, manages denials and reconsiderations, supports reimbursement and coverage, collaborates with physicians and interdisciplinary teams, ensures regulatory compliance, documents reviews, identifies inappropriate utilization, and contributes to staff training and process improvement.

Manage patient account balances by submitting accurate claims, resolving denials and claim edits, following up with payers, reconciling transactions, using payer portals, maintaining compliance with HIPAA and billing regulations, producing reports, and providing patient customer service to maximize revenue cycle performance.

Manage patient account balances by submitting accurate claims, resolving edits and denials, following payer rules and timelines, using payer portals for status checks, reconciling transactions, maintaining productivity metrics, and providing excellent customer service while complying with HIPAA and billing regulations.

Performs accounting and financial analysis for WVU Medicine, including general ledger maintenance, reconciliations, billing, accounts receivable, budgeting, variance analysis, audits, financial reporting, and contract maintenance. Coordinates month-end processes, monitors financial controls, oversees accounting staff, delegates work, trains personnel, and supports quality improvement initiatives.

Performs accounting functions supporting month-end financial statements, budgeting, audits, payroll, reconciliations, journal entries, capital projects, purchase commitments, invoices, and financial controls. Investigates variances, allocates construction payroll, supports procure-to-pay activities, manages capital asset disposition, and prepares documentation for budgets and external audits. The role also assists project managers and supports quality improvement initiatives.

Develops and evaluates radiation therapy treatment plans for oncology patients, including contouring structures, calculating prescribed doses, optimizing beam geometry, and supporting treatment delivery. Uses CT, MRI, and PET imaging, performs quality assurance and dose calculations, assists with simulations and brachytherapy, and collaborates with radiation oncologists, therapists, and medical physicists to ensure accurate, safe treatment implementation.

Leads utilization management operations, denial prevention, clinical appeals coordination, authorization workflows, and reimbursement optimization. Reviews medical records and concurrent denials, determines patient status and next steps, coordinates physician peer-to-peer reviews, monitors quality and KPIs, ensures regulatory compliance, and mentors utilization management staff. Collaborates with clinical, revenue cycle, contracting, payer, and physician advisor teams while supporting process improvement, training, and patient-centered communication.

Performs initial and concurrent utilization reviews for hospitalized and observation patients. Evaluates medical records and medical necessity, determines patient status, communicates with payers and physicians, supports authorization and denial prevention, documents clinical reviews, and promotes appropriate reimbursement and regulatory compliance. The role also collaborates with case management and interdisciplinary teams, identifies utilization delays, supports process improvement, and provides staff training.

Manages hospital patient account balances through accurate claims submission, payer follow-up, denial resolution, account reconciliation, and billing transaction processing. Ensures compliance with federal, state, payer, and HIPAA requirements while monitoring accounts to maximize timely collections. Uses payer portals to verify claim status, researches rejected claims, completes reports, maintains productivity, and provides customer service to patients and internal stakeholders.

Performs initial and concurrent utilization reviews by evaluating medical records, determining patient status and medical necessity, communicating with payers, and supporting authorization and reimbursement. The role manages denials, prepares clinical reconsiderations, collaborates with physicians and interdisciplinary teams, ensures regulatory compliance, identifies inappropriate utilization, documents payer communications, and supports staff training and process improvement.

Post and reconcile insurance and patient payments into Epic, balance postings to bank deposits, resolve unidentified payments, process refunds and remittances, and maintain accurate documentation and reporting for patient accounting.

Manage patient account balances through accurate claim submission, payer follow-up, denial management, and account reconciliation. Use payer portals and phone/email to resolve unpaid or rejected claims, maintain productivity metrics, comply with HIPAA, and support revenue cycle reporting and improvement initiatives.

Manage a team delivering financial and compliance analyses for outpatient/provider-based clinics across WVU Medicine. Train staff, maintain CMS provider-based compliance (42 CFR 413.65), evaluate new clinic setups, produce reimbursement and ad-hoc financial reports, monitor Epic billing designations, and lead cross-functional initiatives to optimize reimbursement and regulatory adherence.

Manage patient account balances and submit accurate claims to third-party payers. Resolve claim edits and denials, follow up with payers via portals, reconcile billing transactions, maintain productivity targets, support reporting and clerical tasks, ensure HIPAA compliance, and provide customer service to patients and staff.

Manage patient account balances by submitting accurate claims, resolving edits/denials, following up with third-party payers, using payer portals, maintaining HIPAA compliance, reconciling transactions, producing reports, and providing customer service to maximize cash receipts.

Lead and coordinate provider-based clinic projects to ensure compliance with CMS regulations, optimize reimbursement, manage stakeholders, develop reports/presentations, perform gap assessments, and drive process standardization and improvements across ambulatory operations.