About the position
Join a team that delivers excellence. Lehigh Valley Health Network (LVHN) is home to nearly 23,000 colleagues who make up our talented, vibrant and diverse workforce. Join our team and experience firsthand what it's like to be part of a health care organization that's nationally recognized, forward-thinking and offers plenty of opportunity to do great work. Imagine a career at one of the nation's most advanced health networks. Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work. LVHN has been ranked among the 'Best Hospitals' by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.
Responsibilities
- Reviews clinical authorization denials and determines appropriate actions per payor to overturn the denial.
- Functions as a hospital liaison with external third-party payors to review authorization denials.
- Monitors and completes claims on team appeals, reconsiderations, and claim investigations.
- Works with the precertification department and other physician offices on authorization denials.
- Prepares spreadsheets to identify issues, patterns, and trends to share and discuss during meetings.
- Develops and monitors payors' responses to identify appeal deadlines within the appropriate timeframe.
- Pursues retro authorization with the appropriate authorization vendor per payor allowance.
- Writes, handles, and submits all administrative appeals with substantiating documentation within deadline restrictions.
Requirements
- High School Diploma/GED
- 2 years professional or facility billing and/or collections for all major third party payers or work experience in healthcare related field.
- Ability to focus on details and coordinate multiple projects simultaneously.
- Ability to read and understand basic medical record documentation.
- Capable of interacting effectively with insurance carriers.
