Work Type: Full Time M – F, No weekends or holidays
Performs post-payment reviews. Handles Government and Non-Governmental payer denials received, provides documentation, prepares and files written appeals timely, reviews accounts for validity for combined admits, responds to Medicare ADRs. At the request of leadership determines the validity of findings and identify areas of revenue opportunity as well as areas of discrepancies in which follow-up and/or education may be necessary. This entails communication within other areas in Revenue Management and GHS to ensure regulations relevant to clinical documentation are being followed and that billing compliance is maintained. Provides data for written reports as requested which may be used for presentation to senior leadership and/or decision making processes. This position may involve the education of clinical or non-clinical personnel in regards to compliant billing practices and handling of denials including written appeal letters.
Reports to the Director of Revenue Management and Hospital Billing
Competencies and Skills:
Demonstrates general computer knowledge and literacy with Microsoft Word and Excel.
Demonstrates excellent communication and written skills.
Demonstrates clinical assessment skills, time management skills, and follow-up skills.
Demonstrates customer focused interpersonal skills to interact in an effective manner with both professional and non-professional staff and payers.
Demonstrates ability to function independently and effectively in a rapidly changing environment as well as the ability to influence and negotiate individual and group decision making processes.
Education and or Experience:
Registered Nurse licensed to practice in state of Pennsylvania required. Clinical knowledge and expertise required.
Minimum of 5 years related nursing experience required
Work is typically performed in a clinical/office environment.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
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.