This position assigns diagnostic and procedural codes using ICD-10-CM and ICD-10-CPT on all medical record types at an advanced level to ensure proper reimbursement and accurate data base information in a multi clinic setting.

Duties and Responsibilities:

• Design and implement processes surrounding proper coding of medical and behavioral health claims.
• Reviews diagnosis and procedure coding within eClinicalWorks on a regular basis, including the establishment of a monthly audit protocol to ensure appropriate coding for optimal billing
• Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insures claim information is complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically.
• Answer patient questions on patient responsible portions, copays, deductibles, write-off’s, etc. Resolves patient complaints or explains why certain services are not covered. Follow up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains.
• Follows up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal.
• Prepares patient statements for charges not covered by insurance. Insures statements are mailed on a regular basis.
• May work with patients to establish payment plan for past due accounts in accordance with provider policies.
• Provides necessary information to collection agencies for delinquent or past due accounts.
• Posts insurance and patient payments using medical claim billing software.
• Secures needed medical documentation required or requested by third party insurance. For patients with coverage by more than one insurer, prepares and submits secondary claims upon processing by primary insurer.
• Follows HIPAA guidelines in handling patient information.
• May periodically create insurance or patient aging reports using the medical practice billing software. These reports are used to identify unpaid insurance claims or patient accounts and to provide support for financial reporting
• Understands managed care authorizations and limits to coverage such as the number of visits. This is encountered often when billing for specialties.
• Coordinate patient information collection related to Sliding Scale Program and Payment Plans
• May have to verify patient benefits eligibility and coverage.
• Stays current with legal and regulatory changes, and local and national trends, in coding.
• Keep abreast of changes in third party reimbursement procedures.
• Collects and submits credentialing information for all providers and submits this information to the appropriate insurance carriers.
• Attend departmental and other meetings as assigned by supervisor.
• Assisting with the creation of Fee Schedules to be submitted to the Board of Directors for approval. Once approved, new fees are edited in eClinicalWorks.
• Other duties as assigned

Knowledge, Skills, and Abilities

• Knowledge of HIPAA confidentiality requirements, maintains strictest confidentiality.
• Knowledge of EMR software, Excel, Word, healthcare databases and clearinghouse software.
• Knowledge of CPT, HCPCS, ICD-9, ICD-10 coding protocols, Medicaid, third party and Medicare billing and coding.
• Knowledge of regulatory standards appropriate for position.
• Ability to understand and apply applicable rules, regulations, policies and procedures.
• Ability to communicate effectively.
• Ability to establish and maintain effective working relationships with clinicians and patients.

Software Access

• Microsoft Office
• eClinialWorks
• Acrobat Pro

Minimum Qualifications

A High School Diploma and three to five years’ experience in insurance billing (CBT Codes). Completion of accredited medical records program i.e., Certified Coding Specialist, Certified Professional Coder or AAPC preferred.

This position compiles and maintains accounting documentation and other tasks as assigned.

Duties and Responsibilities:

• Enter invoices into the accounting software.
• Enter Thrive Assistance Program Assistance payments into accounting software.
• Complete documentation necessary to process payments.
• Custodian of petty cash.
• Distribute payments to vendors.
• Assist with 1099 documentation.
• Assist with contract administration by scanning, filing, advisement of contract expiration, revision of contracts as directed, and obtaining signatures.
• Place online orders by credit card and on account for departments and file documentation as appropriate.
• Assist with ordering janitorial supplies and invoice review as needed.
• Review gas card transactions, add/remove users and vehicles, and generate reports as needed.
• Assist with general credit card reconciliation.
• Assist with purchasing process as it is redefined.
• Assist with maintaining hardcopy and scanned files.
• Assist with security system administration as directed.
• Generate reports as needed in procurement software.
• Communicate with vendors regarding delivery, invoices and related matters.
• Perform online research for materials, supplies and equipment to provide data for decision making.
• Compare invoices to contracts and agreements for accuracy.
• Other duties as assigned.

Knowledge, Skills, and Abilities

• Ability to use computer software including spreadsheets, databases and word processing application
• Ability to multitask and prioritize
• Ability to maintain confidentiality of privileged information obtained in the course of work
• Attention to detail
• Ability to organize and communicate effectively.

Software Access

• Microsoft Office
• Cabinet
• Adobe PDF

Minimum Qualifications

A high school diploma or equivalent and three years general office experience

The Family Nurse Practitioner will be a part of the collaborative team with the physician and ancillary staff to provide comprehensive primary healthcare services using evidence-based medicine to include health promotion, maintenance, family planning, and preventive health.

Duties and Responsibilities:

• Provide comprehensive primary care to patients to include the development of comprehensive medicine plans of care, order laboratory, radiological and diagnostic studies appropriate for complaint, age, race, sex, and physical condition of patient.
• Travel weekly to Florence satellite clinic to provide patient care and as needed to Albertville clinic to provide patient care.
• Complete intake, sexual history, provide testing and offer appropriate treatment in alignment with nationally and locally recognized recommendations.
• Work collaboratively with team of practitioners and clinical team to achieve an evidence based practice, while creating an open and mutually supportive atmosphere for exchange of knowledge and information.
• Document all findings and pertinent data in EMR.
• Share in an on-call rotation for after-hours answering service.
• Close out all charts in a time frame determined by the CFO.
• Review lab results, ensure treatment completed, and ensure appropriate follow up is scheduled.
• Ensure that treatment orders carried out.
• Screen and refer clients to other community service providers as appropriate.
• Work collaboratively with Medical Director to review and treat complex patients and promote the highest standard of care.
• Develop appropriate, patient-specific interventions for risk reduction behaviors based on standard of care.
• Assist the team to find ways to maximize practice efficiency by reducing waste and promoting quality and process improvement.
• Work with medical providers to develop healthcare protocols, procedures, forms, and standing orders as appropriate in order to standardize and improve care.
• Be prepared to educate staff, patients and community on prevention, treatment and interventions.
• Assist in precepting medical, nursing, and dietetic students and residents as needed.
• Support the health center’s goals and objectives including patient engagement and healthcare quality.
• Promote the company’s services to patients and to local community
• Adhere to all Thrive Alabama policies and procedures including grant and funding requirements.
• Maintain continuing education as required by the Alabama Board of Nursing to ensure continued licensure and employment.
• Utilize and promote use of telemedicine to provide quality medical care to patients in the rural and underserved areas across North Alabama.  
• Participate in Quality Improvement Committee and QI projects as assigned.
• Serve as backup to Pediatric Nurse Practitioner.
• Work with the collaborating physician to review quality of care based on evidence based and/or medically validated clinical practices as well as completeness of care.
• Assume all other responsibilities that are assigned by Medical Director or Chief Operating Officer.

Knowledge, Skills, and Abilities

• Knowledge base for the management of health issues generally considered part of primary care.
• Knowledge base for managing HIV, Hepatitis C and STI’s or willingness to acquire this knowledge under direction of Medical Director.
• Ability to maintain a posture of continual learning, accommodation to new information, and investment in externally established standards of care.
• Ability to effectively communicate with patients about their disease to establish patient understanding and commitment to care.
• Ability to develop therapeutic relationship with patients to encourage compliance during care.
• Ability to work with patients, significant others and staff of diverse sexual orientations, cultures, and race
• Ability to effectively communicate with staff.
• Knowledge of nursing principles, practices and techniques.
• Ability to organize, present, and offer education and training programs.
• Ability to establish and maintain effective team relationships with other healthcare personnel and the public.
• Ability to plan, organize and coordinate work assignments.

Software Access

• Microsoft Office
• eClinical Works

Training and Experience or Minimum Qualifications

• Certified or certification-eligible Family Nurse Practitioner in compliance with Alabama Board of Nursing
• Obtain and maintain Collaborative Practice Agreement
• CPR certified

The incumbent in this position serves as a vital member of the healthcare team by utilizing phlebotomy skills to obtain samples from patients for analysis.

Duties and Responsibilities

• Obtain blood specimens by established venipuncture and capillary techniques (adult and pediatric), as well as urine or other samples as ordered by the clinician.
• Process, package, and route specimens to the appropriate laboratory while maintaining specimen integrity by approved laboratory methods.
• Run routine CLIA-waived in-office tests (e.g., urine pregnancy, strep A, influenza, urine dipstick).  Ensure Quality Control is performed and documented.  Troubleshoot if QC is out of acceptable range.
• Ensure safe handling of blood products and proper disposal of hazardous waste.
• Assist in compliance with OSHA standards and AAC policies and procedures for infection control by maintaining a clean and sterile environment, including daily cleaning of the lab and emptying of biohazard bags. 
• Maintain log book(s) for specimens sent each day.
• Receive and enter lab results into the patient's electronic medical record (EMR) and CAREWare.
• Maintain Temperature logs twice a day on the laboratory refrigerator, freezer and room temp.  Troubleshoot if temperatures are out of range.
• Inventory control of laboratory supplies.
• Review pending labs and investigate if any are missing.
• Report equipment or lab deviations to lab supervisor, take action to remediate.
• Collaborate with providers and Director of Nursing to discuss updates on clinical lab tests and specimen collection.
• Conducts investigation into receiving lab or collection discrepancies.  Presents resolutions to supervisor.
• Assist at ancillary sites as needed.
• Participate in Quality Improvement Project.
• Provide coverage at other Thrive Alabama facilities as needed.
• Maintain Phlebotomy certification
• All other duties as assigned. 

Knowledge, Skills, and Abilities

• Knowledge of basic concepts of HIV transmission, prevention and disease process.
• Knowledge of specific laboratory solutions, materials, and media necessary to perform duties.
• Knowledge of HIPAA confidentiality requirements and commitment to safeguarding client information.
• Basic computer literacy for data entry, including Microsoft Excel and EMRs.
• Ability to prioritize needs and plan work assignments accordingly.
• Ability to work with patients, significant others and family members from diverse populations.
• Ability to communicate effectively and maintain working relationships with others.
• Ability to lift and carry a minimum of 30 pounds, sit for extended periods of time, and walk between office buildings.

Software Access

• Microsoft Office
• eClinical Works
• CAREWare

Minimum Qualifications

• High school diploma and at least one (1) year of laboratory experience.
• Certification in Phlebotomy from an accredited college or technical school may substitute for the required experience.

Duties and Responsibilities

• Conduct CLIA waived HIV/Hepatitis C testing on assigned clinic days and on the Mobile Testing Unit (as assigned) with HIV Pre and Post Test Education as assigned by the Director of Health Education.
• Perform triage of patients, medication reconciliation, obtains general health history (to include sexual health), and administers medications and therapeutic injections as ordered by provider.
• Obtain blood specimens by established venipuncture and capillary techniques as well as urine or other samples, as ordered by the clinician while maintaining specimen integrity by approved laboratory methods.
• Assist Provider(s) with examinations as needed, refilling medications, reviewing lab results and notifying patient results as directed by the Provider(s).
• Initiate appropriate referrals to Thrive Alabama for primary care, HIV and Hep C care, facilitates referrals made by provider (s) with appropriate follow up and documentation.
• Assist the nurse supervisor, laboratory technician as requested by the nurse supervisor.
• Receive and enter lab results in to the patient EMR.
• Ensures safe handling of blood products and proper disposal of hazardous waste.
• Completes appropriate serology forms and paperwork for HIV and Hepatitis C testing.
• Communicates with CTR Coordinator in regards to maintaining adequate inventory for testing services.
• Ensures clients complete patient satisfaction surveys and assists the data analyst with CTR, STI and PrEP patient surveys.
• Provide tailored and culturally sensitive educational materials for youth, minorities and LGBTQ community as needed.
• Sanitize and restock supplies used in exam rooms as needed.
• Participate in department team meetings for clinical department, Health Education and Thrive Alabama staff meetings.
• Participate in Quality Improvement projects as directed by the Quality Manager.
• Other responsibilities assigned.

Knowledge, Skills, and Abilities

• Knowledge of HIPAA laws.
• Knowledge of HIV transmission, prevention and disease process
• Ability to work independently with minimum supervision.
• Basic computer literacy skills including but not limited to EMR, MS, Excel and CAREWare.
• Ability to work with patients, significant others and staff from diverse populations.
• Ability to effectively communicate with staff and patients.

Software Access

• Microsoft Office
• eClinical Works
• CAREWare

Minimum Qualifications

• Certification as a Medical Assistant or as a Certified Clinical Medical Assistant (CCMA) by the National Health Career Association (NAH).
• A Certificate, Diploma or Associates degree in Medical Assistant
• Bilingual preferred

Special Note: Every two years, successfully complete 10 C.E.U.s in medically related courses.

This position reports to the CCO and serves as primary internal and external program liaison for all 340B related matters. This includes compliance with regulations related to the 340B Drug Pricing Program. This position conducts monitoring, analyses, investigations and special projects associated with the 340B Drug Pricing Program

Duties and Responsibilities:

• Ensure program integrity and maintain accurate records documenting compliance with all 340B program requirements, state, and federal regulations.
• Review and update 340B program policies and procedures on an ongoing basis and implement according to organizational, state, and federal requirements, training and guidelines for continued compliance.
• Develop, monitor, and present monthly and annual reports on 340B participation that clearly document utilization, savings, problem areas, and exceptions, and/or discrepancies, to be passed on to senior leadership.
• Monitor utilization records and 340B purchasing accounts to ensure software or tools are working properly and accurately, perform audits or compliance assessments internally as needed; work with the CCO to coordinate external compliance assessments with outside firms when appropriate.
• Review and negotiate any new 340B contracts including contract language, fee structure, and data setup for CCO approval. Manage relationships, billing services, compliance and registration for all participating contract pharmacies.
• Actively engage with senior leadership and participate in the review of existing and implementation of new 340B processes to assure mission, vision, goals and performance standards for the agency are met.
• Review and monitor all points of services where 340B participation occurs to ensure policy and procedure compliance, covered entity eligibility, and patient eligibility is met.
• Communicate with all staff involved with 340B program to ensure processes remain efficient and address any problems or suggestions for improvement. Provide ongoing training, education, and communication required for the 340B program.
• Monitor and assess 340B guidance and/or policy changes that affect the 340B program, including HRSA/OPA rules and Medicaid changes.
• Ensure the annual HRSA recertification is completed within the allowable time frame.
• Responsible for ensuring that the HRSA 340B OPAIS account is accurate for all organization entities and ensure new sites are registered timely.
• Perform and document routine internal audits of 340B program and processes to ensure compliance with regulations and identify risk. Coordinate and ensure remediation of findings for general audit-readiness.
• Participate in annual independent 340B compliance audit, coordinating all requests and responses, reporting findings to CCO.
• Coordinate monthly financial reporting and analyses, including, but not limited to, metric reporting, scorecards, and variance analysis and reporting.
• Audit 340B onsite drug inventory.
• Audit, and report 340B pharmaceutical sales and purchases data to ensure provider/physician and patient eligibility.
• Audit vendor accounts to ensure 340B ID’s are matched correctly to the corresponding facility account when purchasing 340b drugs for onsite dispensation.
• Regularly monitor 340B purchasing activity and compliance with established protocols.
• Lead the 340B Committee meetings on a quarterly basis.
• Participate in work groups and offer contributions and recommendations to improve processes, procedures, quality, consistency, and compliance for the 340B program, as needed.
• Assist with defining and testing internal controls, audit procedures, automation, and improvement recommendations.
• Work with CCO to coordinate an annual audit of all contract pharmacies. Document results and follow-up on any findings.
• Conduct monthly audits of 340B eligible locations to verify adherence with the 340B program guidelines and policies.
• Perform other duties as assigned.

Knowledge, Skills, and Abilities:

• Knowledge of compliance and regulations related to the 340B drug pricing program
• Knowledge of policy changes affecting 340B program including HRSA/OPA rules and Medicaid changes.
• Knowledge of procedures and operations of a 340B drug discount program in a clinic setting
• Experience/skill with spreadsheet applications and analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions.
• Ability to prepare, analyze and interpret data.
• Ability to plan, organize and coordinate work assignments.
• Ability to communicate effectively.
• Ability to establish and maintain effective working relationships with others.

Software Access:

• Microsoft Office
• eClinicalWorks

Minimum Qualifications:

Education:

Bachelor's degree in Pharmacy, Business, Accounting, Finance or Healthcare Administration.

Experience Preferred:

5 years experience in 340B Administration, audit, healthcare, pharmacy purchasing, or healthcare inventory management.

Trainings and Certifications Preferred:

340B University or Apexus Advanced Training and Certification

Duties and Responsibilities

• Assists, make appointments, and follow up on appointment completion for clients by referring them for additional supportive services, including housing, dental, mental health, eye glasses, and substance abuse services.
• Conduct intakes/reassessments annually (psychosocial assessments) and conduct six (6) month follow-up.
• Develop individual treatment plans with clients to determine and accomplish goals based on the outcome of the psychosocial assessments.
• Work with all youth (24 and below) as the Youth Social Worker.
• Ensure that Ryan White funds are the payer of last resort while fulfilling the needs of the clients.
• Complete post-test education sessions (PTE).
• Assist clients with completing and processing Social Security Disability, Unemployment, and Food Stamp Applications.
• Complete an Annual Household Budget Assessment with the client.
• Teach life enhancement skills through educational training.
• Align clients with community resources to meet any needs exceeding the scope of the organization.
• Assist clients with enrollment in qualified health insurance plans through Alabama's Marketplace.
• Provide psychosocial support to clients.
• Assist clients with questions regarding prescription drug coverage, including applications to pharmaceutical patient assistance programs.
• Correspond, collaborate, and process the required applications and documents with the pharmacies and pharmaceutical companies to obtain the client’s medications.
• Complete applications, recertifications, and revisions for the Alabama AIDS Drug Assistance Program (ADAP).
• Complete Medicaid verifications and chart reviews, as needed.
• Complete daily documentation in both the electronic health record (eClinicWorks) and the supplemental database (CAREWare).
• Submit monthly documentation and reports, including billing sheets, to the Director of Case Management Services and Chief Financial Officer.
• Participate in daily Team Meeting with the Medical Provider to discuss client treatment for the scheduled clients of the day.
• Provide client transportation as needed to medical and mental health appointments.
• All other duties, as assigned.

Knowledge, Skills, and Abilities

• Knowledge of the concepts and principles of case management.
• Strong desire to work with minority populations, including men who have sex with men (MSM).
• Ability to communicate effectively and maintain working relationships with people from diverse ethno-cultural backgrounds.
• Ability to establish and maintain effective team relationships with other community organizations and the public.
• Ability to prioritize needs and plan work assignments accordingly.
• Fluency is basic computer systems, including Microsoft Office.
• Knowledge of HIPAA confidentiality requirements.

Software Access

• Microsoft Office
• eClinical Works
• CAREWare
• Adobe Reader

Minimum Qualifications

Master's degree in social work with licensure by the State of Alabama (LMSW) and at least three (3) years of case management experience. Bilingual in both English and Spanish language preferred but not required.