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Geisinger
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Geisinger ir Pensilvānijā bāzēta veselības aprūpes organizācija, kas vietējām kopienām nodrošina pieejamus medicīnas pakalpojumus un inovatīvu pacientu aprūpi. Organizācija, kas dibināta 1915. gadā, pieņem darbā speciālistus māszinībās, citās veselības aprūpes jomās, administrācijā un citās ar veselības aprūpi saistītās funkcijās, īpašu uzmanību pievēršot profesionālajai izaugsmei un darba videi, kurā tiek novērtēta daudzveidība, vienlīdzība un iekļaušana.
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Vakances uzņēmumā

Coding and Cost Analyst I

Review Geisinger Health Plan claims, coding, and reimbursement, and recommend potential recoveries. Validate high-dollar claim payments against healthcare regulations and plan contracts.

USAmerikas Savienotās ValstisPAPensilvānijaHibrīdiPilna slodzeVidējais līmenisVecākais speciālistsNepieciešamā Valoda: angļuAnalītiķis

Apraksts

  • Review billed services, authorizations, benefit documents, itemized statements, medical records, discharge summaries, and detailed reports.
  • Recommend reimbursement or recovery based on coding, billing data, policies, industry standards, contracts, and applicable regulations.
  • Advise Health Plan departments on accurate coding, billing, and reimbursement.
  • Conduct clinical reviews for claims, claim edits, appeals, and grievances.
  • Help assess clinical risk for Underwriting, Pharmacy, and Finance.
  • Recommend recoveries in line with contracts, policies, procedures, and industry standards.
  • Review and validate pended and reconsidered claims using CPT, industry, and CMS guidelines.
  • Review high-dollar inpatient and outpatient claims and support quality concern reviews.
  • Validate claim payments against plan contracts in coordination with Pharmacy and PNM departments.
  • Create and maintain departmental tracking reports.
  • Join discussions about complex medical reviews.
  • Help onboard new team members.
  • Participate in assigned workgroups and committees.

Prasības

  • High school diploma or GED required.
  • AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS) credential required.
  • At least three years of relevant experience required.
  • Relevant experience may include related work and completed specialty training.
  • One year of specialty training counts as one year of relevant experience.
  • LPN credential preferred.
  • At least two years of clinical experience preferred.
  • Computer literacy.
  • Critical thinking skills.
  • Organizational skills.
  • A secure home office that meets HIPAA Privacy standards.
  • Ability to follow organizational policies and procedures.

Priekšrocības

  • Healthcare coverage for full-time and part-time employees starting on day one.
  • Vision coverage.
  • Dental coverage.
  • Domestic partner benefits.
  • Work-from-home arrangement.
  • Occasional onsite department meetings as needed.

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