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Job Summary

Serves as the lead consultant and educator to staff and administration for related reimbursement, strategic savings initiatives and coding compliance issues. Assesses 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

Minimum of one Certification is required:
CPC - Certified Professional Coder through AAPC

CRC - Certified Risk Adjustment Coder through AAPC

RHIT - Registered Health Information Technician through AHIMA

• Provides day-to-day consultative support and advice regarding coding of services rendered, recommended reimbursement for services, health plan policies regarding reimbursement methodologies for all types of provider contracting.
• Develops and demonstrates exceptional proficiency and expertise in all reimbursement methodologies and pertinent industry information.
• Knowledge must include an extensive understanding of current and future reimbursement strategies and concepts.
• Keeps fully informed of current and anticipated changes in Medicare and other third party payor reimbursement regulations and advises leadership of the possible effects.
• Requests impact analysis on proposed and final regulation changes and makes recommendations based on outcomes.
• Performs data and various forms of market research identifying business opportunities, translates information and develops concrete business plans.
• Oversees the delegation of responsibilities for assuring all new codes are revised for addition to appropriate fee schedules in order to maintain compliance with federal regulations.
• Includes reviewing existing fee schedules for possible retirement, applicability of code additions and applying correct payment methodologies.
• Serves an integral role with other members of the team in the design, implementation and evaluation of reimbursement initiatives.
• Supports the directors, negotiators, or other leadership in researching and assessing new or enhanced reimbursement initiatives.
• Identifies and communicates revised reimbursement strategies with consideration of all financial or operational implications.
• Oversees the implementation of operational changes that occur as a result of reimbursement changes.
• Reviews reimbursement opportunities by utilizing statistical reports, reimbursement summary documents and chart auditing outcomes, to conduct reviews and analysis of coding practices and fee levels in order to determine appropriateness of coding practices, charging practices and fees of the provider network.
• Assists in the recovery of inappropriately billed charges.
• Prepares and presents reports along with recommendations and advice to leadership.
• Keeps abreast of current reimbursement methodologies in order to provide technical resources regarding all reimbursement systems responsibilities.
• Supports the maintenance of policies and procedures, and assists in the development of departmental policies related to standard departmental functions.
• Reviews information from external consultants and other third party vendors to assist in the selection process.
• Works closely with external vendors to facilitate the implementation and training process.
• Proactively reviews process, makes alternative suggestions when necessary in order to achieve optimum results.
• Assists in the technological aspects of planning and coordinating processes used to achieve maximum efficiencies and maintain regulatory compliance.

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

Education

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

Experience

Minimum of 10 years-Relevant experience* (Required)

Certification(s) and License(s)

Registered Health Information Technician (RHIT) - American Health Information Management Association; Certified Professional Coder - American Academy of Professional Coders (AAPC); Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC)

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. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

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.

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