Job Title: Reimbursement Service Coordinator Intermediate
Location: Geisinger Health Plan, Hughes
Department: Customer Service Support
Work Type: Full Time
Serves as a consultant and educator to Senior Reimbursement Team, departmental staff, Medical Directors, and 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.
With direction from the Senior Reimbursement team, 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 analytical, problem solving and strategic thinking skills combined with strong organizational skills.
Demonstrates the ability to perform industry research related to third party reimbursement issues and make recommendations based on findings.
Demonstrates strong oral and written communication skills with varying levels of Health Plan personnel.
Demonstrated self-motivated attitude and the 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 assigned projects, gather necessary resources and produce a finished product, as well initiating responsible actions.
Demonstrates exceptional knowledge of procedural coding (CPT, HCPCs, appropriate use of modifiers, etc.)
Demonstrates working knowledge of UB04 and CMS 1500 claim forms.
Demonstrates comprehensive knowledge of Medicare Part B and other third party reimbursement/regulatory systems, including managed care, required.
Education and or Experience:
Bachelors Degree in Accounting, Finance or a Healthcare related subject required. Minimum of 3 years related professional work experience in a progressive healthcare setting required.
Associates Degree in Accounting, Finance or a Healthcare related subject required. Minimum of 6 years related professional work experience in a progressive healthcare setting may substitute for the Bachelor's Degree requirement above.
Minimum of 9 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 required after two years in the position.
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.
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.
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. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. 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.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
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.