[Hiring] Reimbursement Coordinator Intermediate @Geisinger

Role Description

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.

• 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 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.
• Assists 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.

Qualifications

• High School Diploma or Equivalent (GED) - Required
• Minimum of 8 years of relevant experience - Required

Requirements

• Communication
• Multitasking
• Teamwork
• Working Independently

Benefits

• Healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.
• Encourages an atmosphere of collaboration, cooperation and collegiality.

Company Description

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.