Job Summary

The Practice Consultant (PC) acts as a consultant and clinical subject matter expert on clinical charge capture strategy and workflow, reimbursement, and regulatory policy for their identified clinical area. Provides strategic direction to facilitate maximization of clinical revenue and oversees activities associated with assigned clinical areas. Investigates current processes, assessing efficiency and accuracy, and provides solutions for problems and process improvement.

Job Duties

• Acts as the subject matter expert for their assigned clinical areas to the broader Revenue Management team
• Interacts with staff to optimize productivity and efficiency
• Analyzes and reports on any findings related to performance indicators for their clinical areas
• Advise staff on proper procedures related to use of systems and clinical tools (charge entry screens, charge router, orders, documentation templates, encounter types, work queues etc.)
• Performs process analysis and identifies and/or participates in Revenue Integrity process improvement
• Owns assigned clinical area’s accounts in relevant work queues to ensure they stay current while identifying trends and issues to evaluate for system process improvements.
• Works in conjunction with applicable team to monitor, react, and make necessary updates for hospital-based revenue routing accuracy.
• Engage with professional and hospital billing teams on denial activity to identify trends and formulate plans on how to decrease and or prevent denials.
• Review and analyze write off activity to identify trends and formulate plans on how to decrease and / or prevent write offs.
• Identify, submit, follow through on issues or process improvements found within the billing system workflows.
• Monitors and communicates information regarding commercial payer policy and regulatory policy changes, identifies the effect these changes have on the department and the clinical enterprise, and works with stakeholders to develop compliant remediation strategies.
• Reviews KPI performance data including but not limited to charging, denials, lag days, etc. and identify areas of opportunity.
• Prepares reports and/or presentations to communicate performance metrics and potential opportunities for the assigned clinical service line.
• Collaborates with other departments on items including but not limited to new service auditing and general reconciliation activities.

Work is typically performed in an office environment. Travel may be required. 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.

Education

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

Experience

Minimum of 6 years-Relevant experience* (Required)

Skills

Waterfall Model; Working Independently; Communication; Computer Literacy

About Geisinger

Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.

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.

Our Vision & Values

Everything we do is about making better health easier 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.

Our Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.