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Geisinger · 1 day ago

Manager Reimbursement Services (CPC, CRC, or RHIT), Geisinger Health Plan

Danville, PA

Full-time

Onsite

Mid, Senior Level

3+ years exp

Geisinger is a healthcare organization seeking a strategic and experienced leader to oversee their Reimbursement Services team. The role involves guiding the planning, analysis, and implementation of reimbursement methodologies for healthcare providers, managing reimbursement initiatives, and collaborating with senior leadership on financial strategies.

Health CareHospitalMedical

Responsibilities

Oversees the Reimbursement Services team members who lead the planning, analysis, consultation and direction of the reimbursement methodology for healthcare providers

Oversees short and long term reimbursement initiatives with the ability to work closely with senior management to develop strategic goals and implement reimbursement initiatives

Leads the forecasting process related to changes in reimbursement methodology and associated financial impact

Oversees daily coding and reimbursement support to negotiations, claims processors and provider set-up representatives

Coordinates and provides oversight for the ongoing analysis and planning of industry reimbursement changes

Coordinates ongoing physician fee changes and primary care capitation analysis

Provides impact analysis as fee changes occur

Coordinates the ongoing fee revision process

Ensures efficient and timely processing of problem claims for all lines of business and all markets, including new and expansion markets

Monitors and evaluates provider-specific payment waivers and distinctive edit exclusions negotiated within the provider network

Consultative activities with internal and external customers to assist with the development of reimbursement strategies related to TPA or new market relationships

Provides consultative support on all financial planning issues related to provider reimbursement

Evaluates reimbursement initiatives and changes in payment to control medical expense

Leads implementation of new or existing predictive modeling software tools, as well as, supports the accuracy and integrity of reimbursement related information

Assists with presentations to provider network managers to educate on industry trends in reimbursement, reimbursement changes and tools and templates available for requesting reports on historical provider reimbursement

Ensures that accurate predictive modeling is done by line of business (Medicare versus Commercial)

Recommends reimbursement opportunities by utilizing statistical reports, reimbursement summary documents and industry information to conduct review and analysis of coding practices or fee levels

Determines appropriateness of provider coding and charging practices and associated claims processing payment accuracy to validate actual provider payment against contracted payment terms

Qualification

CPC certificationCRC certificationRHIT certificationHealthcare reimbursementFinancial analysisConsultative supportLeadershipTeam management

Required

Bachelor's Degree- (Required)

Minimum Of 3 Years-Managing People, Processes, Or Projects (Required)

A minimum of one certification is required: CPC, CRC, or RHIT

Preferred

Bachelor's Degree-Business Administration/Healthcare Management (Preferred)

Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.

Company

Geisinger

Glassdoor3.5

Geisinger is a health and wellness organization that offers orthopaedic, weight-management, and heart care services. It is a sub-organization of Risant Health.

Founded in 1915

Danville, Pennsylvania, USA

10001+ employees