Reimbursement Coordinator Intermediate, Geisinger Health Plan (EasternStandardTime Zone resident)

Geisinger; Elm (PA); Remote; USD 90,000 - 120,000; Full time

Job summary

Geisinger is seeking an experienced reimbursement consultant and educator to support staff and administration on reimbursement practices, coding compliance, and strategic savings initiatives. You will assess existing and prospective reimbursement practices, provide recommendations based on contracts, policies, and industry standards, and ensure compliance with applicable regulations.

The role involves analyzing reimbursement opportunities, developing strategies, presenting reports to leadership,

Qualifications

• Minimum 8 years related experience in reimbursement, coding, or health plan environments.
• Experience providing consultative reimbursement guidance to staff and leadership.
• Familiarity with contracts, policies, and regulatory requirements.

Responsibilities

• Interacts with staff to provide reimbursement consultative support and advice on reimbursement methodologies.
• Discusses current and future reimbursement initiatives and policy impacts.
• Assists with educational presentations and acts as a senior member of the training team.

Skills

Communication

Multitasking

Teamwork

Independent work

Education

High School Diploma or Equivalent (GED)

Job description

Location: Work from home (Pennsylvania)

Shift: Days (United States of America)

Scheduled Weekly Hours: 40

Worker Type: Regular

Exemption Status: Yes

Job Summary

Serves as a consultant and educator to staff and administration for reimbursement, strategic savings initiatives and coding compliance issues. Assists in assessing existing and prospective reimbursement practices. Provides recommendations as to appropriate reimbursement based on current contracts, policies, and accepted industry practices while ensuring compliance with contractual, state and federal regulations.

Job Duties

• Interacts with all levels of staff in order to provide consultative support and advice regarding reimbursement for services rendered and policies regarding reimbursement methodologies.
• Includes discussions on current and future reimbursement initiatives, as well as any other pertinent information that may affect reimbursement processes.
• Assists with ongoing educational presentations.
• Serves as a senior member of the training team.
• Reviews reimbursement opportunities by utilizing statistical reports, reimbursement summary documents and other analytical measured procedures; conducts reviews and analysis of coding practices and fee levels in order to determine full impact.
• Plans for reimbursement strategy.
• Prepares and presents reports along with recommendations and advice to leadership.
• Creates ad hoc reporting for review and analysis to show impact estimation to reimbursement for implementing policy revisions and changes in reimbursement levels.
• Responsible for assisting in the development, review and revision of reimbursement schedules as needed.
• Includes developing code set and payment methodologies using concepts that promote the strategic growth initiatives.
• Assumes lead and delegation of responsibilities for assuring all new codes are reviewed for addition to appropriate fee schedules in order to maintain compliance with federal regulations.
• Provides consultative support and serves as department liaison regarding the research and resolution of appropriate coding of services rendered, recommended reimbursement for services, health plan policies regarding coding and reimbursement methodologies for all types of provider contracting.
• Assists in the development of the data and planning needs.
• Draws conclusions based on operational research and data analysis.
• Analyzes and complies research into actionable conclusions.
• Provides pricing recommendations to various departments.
• Assists in the completion of a comprehensive review of designated provider claims information to identify reimbursement opportunities in order to assist in the recovery of inappropriately billed services.
• Conducts analysis based on billed statistics, current coding and charging practices and industry information.
• Keeps abreast of current reimbursement methodologies in order to provide technical resources regarding all reimbursement systems responsibilities.
• Provides proficiency and expertise in data applications and reporting tools.
• Assist in the development and maintenance of detailed, easy to follow, resource-intensive web pages to be used by staff and other departments as applicable.
• Updates the master fee schedule containing the current and historical reimbursement rates for contracted providers, hospitals, etc.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

*Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 8 years-Relevant experience* (Required)

Skills

Communication, Multitasking, Teamwork, Working Independently

OUR PURPOSE & VALUES

Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.

• KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE: We treasure colleagues who humbly strive for excellence.
• LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
• INNOVATION : We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
• SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.