Job Summary

Serves as a supportive consultant and educator to staff and administration for related 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 applicable 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 an active 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.
• 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 development, review and revision of reimbursement schedules.
• Supports physician fee changes and contract negotiations.
• Provides supportive impact analysis as fee changes occur.
• Maintains and updates an accurate master fee schedule that contains the current and historical reimbursement rates for contracted providers, hospitals, etc.
• Develops and maintains quarterly Medicare fee schedules.
• Develops and maintains current percentage of Medicare data using current fee schedule rates and payments.
• Develop a weighted comparison of previous and existing Medicare payments to provider fee schedule using claims utilization.
• 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.
• Develops and maintains detailed, easy to follow, resource-intensive departmental web pages to be used by appropriate staff and other departments as applicable.

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).

Position Details

Facets experience preferred.  

Microsoft Access, Excel and SQL experience needed

Internet requirements:

​Employee required to have/supply: Cable modem, (high speed, only - No DSL or Wireless Cellular Service or Satellite Service) The minimum requirement is:

• •25 MBPS UP
• •75 MBPS DOWN
• •<150 ms Ping Required
• •<30ms Jitter Required

Computer must be connected to the internet via Ethernet cable; wifi is not permitted unless a Virtual Private Network (VPN) is used for the wifi connection

Education

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

Experience

Minimum of 6 years-Relevant experience* (Required)

Skills

Communication; Teamwork; Multitasking; Working Independently

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.

Our Commitment to Diversity, Equity and Inclusion

Geisinger values who you are, where you are from, and where you are going. We seek out people of various backgrounds and cultures with unique abilities, non-traditional career paths and ambitious aspirations. We are an Affirmative Action, Equal Opportunity Employer. Women and Minorities are encouraged to apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status. Read more about Our Commitment to Inclusive Recruiting.

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.