Reimbursement Coordinator Intermediate, Geisinger Health Plan (Eastern Standard Time Zone resident)

Geisinger • Work from home (Pennsylvania), PA

1d • Remote

About The Position

The Reimbursement Coordinator Intermediate serves as a consultant and educator to staff and administration on reimbursement, strategic savings initiatives, and coding compliance. The role helps assess existing and prospective reimbursement practices and recommends appropriate reimbursement based on current contracts, policies, and accepted industry practices while ensuring compliance with contractual, state, and federal regulations.

This position provides consultation and advice across staff levels; supports reimbursement education and training; reviews reimbursement opportunities and coding practices; develops reimbursement strategies and recommendations; and contributes to fee schedule development and maintenance. It also conducts operational research and data analysis, prepares reports for leadership, provides pricing recommendations, supports claims reviews to identify recovery opportunities, and maintains reimbursement resources and master fee schedules. The position is work from home in Pennsylvania and is designated for Eastern Standard Time Zone residents. Work is typically performed in an office environment.

Requirements

• High school diploma or equivalent (GED).
• Minimum of 8 years of relevant experience; relevant experience may be a combination of related work experience and education, with an associate degree equivalent to 2 years and a bachelor's degree equivalent to 4 years.
• Communication skills.
• Multitasking skills.
• Teamwork skills.
• Ability to work independently.

Responsibilities

• Provide consultative support and advice to staff at all levels regarding reimbursement for services and reimbursement methodologies.
• Discuss current and future reimbursement initiatives and information that may affect reimbursement processes.
• Assist with ongoing educational presentations and serve as a senior member of the training team.
• Review reimbursement opportunities using statistical reports, reimbursement summaries, and other analytical procedures; analyze coding practices and fee levels to determine their impact.
• Plan reimbursement strategy and prepare and present reports, recommendations, and advice to leadership.
• Create ad hoc reports to estimate the reimbursement impact of policy revisions and changes in reimbursement levels.
• Assist in developing, reviewing, and revising reimbursement schedules, code sets, and payment methodologies.
• Lead and delegate review of new codes for addition to appropriate fee schedules to maintain federal regulatory compliance.
• Serve as a department liaison and provide consultation on coding services, recommended reimbursement, health plan policies, and reimbursement methodologies for provider contracting.
• Assist with data and planning needs; conduct operational research and data analysis; and translate research into actionable conclusions.
• Provide pricing recommendations to various departments.
• Assist with comprehensive reviews of designated provider claims to identify reimbursement opportunities and support recovery of inappropriately billed services.
• Analyze billed statistics, current coding and charging practices, and industry information.
• Keep current with reimbursement methodologies and provide technical resources for reimbursement systems responsibilities.
• Use data applications and reporting tools proficiently.
• Assist in developing and maintaining detailed, easy-to-follow resource web pages for staff and other departments.
• Update the master fee schedule containing current and historical reimbursement rates for contracted providers, hospitals, and others.
• Comply with job-specific obligations and organizational policies and procedures.

Benefits

• Healthcare benefits for full-time and part-time positions from day one, including vision, dental, and domestic partner benefits.
• Collaborative, cooperative, and collegial work atmosphere.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED