Reimbursement Coordinator Intermediate, Health Plan; Eastern Standard Time Zone resident

Location:

Work from home (Pennsylvania)

Shift: Days (United States of America) Scheduled Weekly

Hours:

40 Worker Type:
Regular Exemption Status:
Yes

Job Summary:

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.

Job Duties:

Interacts with all levels of staff in order 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 in order 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.

Assist 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.

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).

Education:

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

Experience:

Minimum of 8 years-Relevant experience* (Required)

Certification(s) and License(s):

Skills:

Communication, Multitasking, Teamwork, Working Independently

• 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…