Serves as a supportive consultant and educator to Senior Reimbursement team, departmental staff or other Health Plan Administration for Health Plan related reimbursement, strategic savings initiatives and coding compliance issues. Assists Senior Reimbursement team 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.
Under the direction and supervision of the Senior Reimbursement team and working with a team of peers, assists in the development of training and process improvement efforts for Provider Network Management and Geisinger Health Plan.
Reports to the Director, PNM Reimbursement Services.
COMPETENCIES AND SKILLS:
Demonstrates strong oral and written communication skills and ability to work well with others.
Demonstrates strong analytical, problem solving and strategic thinking skills combined with strong organizational skills.
Demonstrates the capability to use databases and analytical software programs.
Demonstrates ability to provide supportive analysis and report interpretation to Senior Reimbursement team. Develop clear conclusions and summarize findings.
Demonstrates ability to work effectively as a team member, including the ability to work, plan, research, and conduct projects with minimal supervision.
Demonstrates ability to organize and prioritize workload to manage multiple tasks and meet deadlines.
Demonstrates the ability to work independently in a dynamic work environment with accuracy and strict attention to detail, formulate decisions and recommendations and be directly accountable for performance.
Demonstrates the ability to carry out defined procedures and duties under specific instructions, as well as capability of initiating responsible actions.
Demonstrates knowledge of procedural coding (CPT, HCPCs, appropriate use of modifiers, etc.)
Demonstrates comprehensive knowledge of Medicare Part B and other third party reimbursement/regulatory systems, including managed care, required.
The specific statements shown above are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job
EDUCATION AND/OR EXPERIENCE:
Bachelor’s Degree in Accounting, Finance or a Healthcare related subject required. Minimum of 1 year related professional work experience in a progressive healthcare setting required.
Associate’s Degree in Accounting, Finance or a Healthcare related subject required. Minimum of 4 years related professional work experience in a progressive healthcare setting may substitute for the Bachelor's Degree requirement above.
Minimum of 7 years equivalent related professional work experience in a progressive healthcare setting and record of exemplary performance may substitute for the Degree requirements above.
CPC Certification preferred
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment
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.
GEISINGER HEALTH PLAN (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries.
About Geisinger: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.