Coding and Cost Analyst I, Geisinger Health Plan (Easter Standard Time Zone res
工作地点：从家 （宾夕法尼亚）班次：日期 （美国）计划周休：40个工类型：定期豁免状态：无职位总结：通过对收费服务，授权，计划福利文件，详细声明，医疗记录，退款总结和详细数据报告进行全面审查，为组织实现战略和财务目标做出贡献。根据适当的编码，收费统计，政策，行业标准以及合同，州和联邦规定遵守，提供偿还或恢复建议。工作责任：· 通过提供对正确编码，适当的发票和退款的审查和建议，为其他卫生计划部门提供支持并作为资源。· 完成与索赔，索赔修改，上诉和投诉过程有关的临床评估，协助分析与承书，药品和财务部门相关的临床风险。· 在现行合同，政策，程序和接受的行业标准基础上推恢复努力。· 审查和验证正在待定和重新考虑的要求，当该计划应用了来自多家供应商的索赔编辑软件时修订。评价通常基于 CPT 指南，行业标准和 CMS 指导方针。· 根据内部指导方针完成住院和外院高美元要求的审查。协助评估质量问题。· 验证基于计划合同的申请支付，经常与药房团队和 PNM 部门合作。· 创建并维护各种报告来跟踪部门数据。· 在需要时帮助新团队成员加入组讨论。· 按要求参加特定的工作组和委员会。通常在家办公室工作中进行，该工作必须安全且遵守 HIPAA 隐私标准。负责履行所有职位特定义务，并遵守组织的所有政策和程序。本配置文件中的具体声明不包括一切。它们代表了被认为是成功执行工作的典型元素。职位详细信息：任何部门特定指导中概述的额外能力和技能将被视为与该职位相关的工作进行基本。根据需要偶尔参加局部会议。*相关的 e
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Location:
Work from home (Pennsylvania)Shift:
Days (United States of America)Scheduled Weekly Hours:
40Worker Type:
RegularExemption Status:
NoJob Summary:
Contributes to the achievement of the strategic and financial goals of the organization by conducting thorough reviews of billed services, authorizations, plan benefit documents, itemized statements, medical records, discharge summaries and detailed data reports. Makes reimbursement or recovery recommendations based on appropriate coding, billed statistics, policies, industry standards and compliance with contractual, state, and federal regulations.Job Duties:
- Supports and serves as a resource to other Health Plan departments by providing review and recommendation for correct coding, appropriate billing, and reimbursement.
- Completes clinical reviews related to Claims, Claim Edits, Appeals and the Grievance process, assisting in analysis of clinical risk related to Underwriting, Pharmacy, and Finance departments.
- Recommends recovery efforts based on current contracts, policies, procedures and accepted industry standards.
- Reviews and validates pended and reconsidered claims when edits are applied by the Plan claim editing software from multiple vendors. Reviews are typically based on CPT guidelines, industry standards and CMS guidelines.
- Completes reviews on inpatient and outpatient high dollar claims following internal guidelines. Assists in reviews of quality concerns.
- Validates claim payments based on Plan contracts, often working with the Pharmacy team and the PNM department.
- Creates and maintains various reports to track department data.
- Assists in group discussions on challenging medical reviews.
- Assists with onboarding new team members as needed.
- Participates on selected workgroups and committees on an ad hoc basis as requested.
Work is typically performed in a work-from-home office which must be secure and follow HIPAA Privacy standards. 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.
Position Details:
Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.
Attend occasional onsite department meetings as needed.
*Relevant experience may be a combination of related work experience and/or completed specialty training program (1 year of specialty training = 1 year relevant experience).
CPC-Certified Professional Coder through AAPC, or CCS- Certified Coding Specialist through AHIMA required, LPN preferred.
Education:
High School Diploma or Equivalent (GED)- (Required), Graduate from Specialty Training Program- (Preferred)Experience:
Minimum of 3 years-Relevant experience* (Required), Minimum of 2 years-Clinical (Preferred)Certification(s) and License(s):
Certified Coding Specialist - American Health Information Management Association (AHIMA), Certified Professional Coder - American Academy of Professional Coders (AAPC)Skills:
Computer Literacy, Critical Thinking, Organizing
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, we encourage an atmosphere of collaboration, cooperation and collegiality.
Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.
Originally posted on Himalayas