Remote Reimbursement Strategy Lead

Geisinger; United States; Remote; USD 90.000 - 130.000; Vollzeit

Benefits dieser Stelle

Healthcare benefits from day one

Vision and dental benefits

Domestic partner benefits

Zusammenfassung

Geisinger is seeking a reimbursement consultant and educator to support staff and administration in areas of reimbursement, strategic savings, and coding compliance.

You will assess current and prospective reimbursement practices and provide recommendations aligned with contracts, policies, and regulations while ensuring compliance. The role emphasizes education, leadership in training, and data-driven reporting.

Qualifikationen

• High School Diploma or GED required.
• Minimum of 8 years of relevant experience required.
• Excellent communication, multitasking, teamwork, and ability to work independently.

Aufgaben

• Interacts with all levels of staff 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.

Kenntnisse

Communication

Multitasking

Teamwork

Working Independently

Ausbildung

High School Diploma or GED

Jobbeschreibung

Geisinger is seeking a reimbursement consultant and educator to support staff and administration in areas of reimbursement, strategic savings, and coding compliance.

You will assess current and prospective reimbursement practices and provide recommendations aligned with contracts, policies, and regulations while ensuring compliance. The role emphasizes education, leadership in training, and data-driven reporting.