Acts as a leader, liaison, and resource working collaboratively with a diverse group, including management, physicians, clinical and non-clinical personnel utilizing the national correct coding standards, approaches, and industry standard coding rules to support and expand internal and external strategies.
- Applies expanded knowledge of CPT, ICD-10 and HCPCS coding skillstoward the maintenance and development of prospective claim edits and partnerships.
- Determines payment compliance with clinical and reimbursement policies.
- Researches CPT codes to clarify coding issues, as required.
- Determines opportunities with current vendor partnerships and implementations, exploring new opportunities as well.
- Coordinates, reviews, and recommends changes for the yearly opportunity analysis.
- Reviews and responds to claim edit appeals and rational requests.
- Coordinates, supports, and resolves vendor needs both prospectively and retrospectively.
- Problem solves system/claim edit issues that may come up.
- Tests and verifies new claim edits as a component of maintenance and during implementation for new vendors
- Leads the Edit Expansion Committee as a component
- Leads routine maintenance and oversight meetings with vendor partners
- Acts as a subject matter expert in support of internal workgroups/committees, etc.
- Interacts with providers and/or Account Managers to clarify documentation and billing issues identified.
- Leads internal development, testing, maintenance, and expansion of internal claims edits.
- Leads the development of the ClaimsXten Policy Management Module.
- Mentors less experienced staff and new hires.
- Compiles and coordinates routine performance reporting for various vendor initiatives and supports various report out meetings.
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. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.
minimum 1 certification required CPB, CPC, RHIT
CPC Certification - PREFERRED
High School Diploma or Equivalent (GED)- (Required), Graduate from Specialty Training Program- (Preferred)
Minimum of 5 years-Related work experience (Required), Minimum of 5 years-Health Insurance/Managed Care (Preferred)
Certification(s) and License(s)
Registered Health Information Technician (RHIT) - American Health Information Management Association; Certified Professional Biller - American Academy of Professional Coders (AAPC); Certified Professional 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 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.
Geisinger is committed to making better health easier for the more than 1 million people it serves. Founded more than 100 years ago by Abigail Geisinger, the system now includes nine 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 1,600 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.