Manager, Reimbursement Services

Job not on LinkedIn

October 30

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

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Geisinger

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Healthcare • Pharmaceuticals • Wellness

Geisinger is a healthcare organization that has been providing accessible medical services for over a century in Pennsylvania. It focuses on meeting the healthcare needs of its communities and is dedicated to innovative patient care. With career opportunities in various fields including nursing, allied health, and administration, Geisinger promotes professional development and a supportive workplace for its employees, emphasizing diversity, equity, and inclusion.

10,000+ employees

Founded 1915

💊 Pharmaceuticals

🧘 Wellness

📋 Description

• 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.

🎯 Requirements

• Bachelor's Degree- (Required) • Bachelor's Degree-Business Administration/Healthcare Management (Preferred) • Minimum of 3 years-Managing people, processes, or projects (Required) • Certified Professional Coder - American Academy of Professional Coders (AAPC) • Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC) • Registered Health Information Technician (RHIT) - American Health Information Management Association • Builds Relationships • Computer Literacy • Manages Conflict And Crisis • Manages Projects And Functions • Mathematics

🏖️ Benefits

• healthcare benefits for full time and part time positions from day one • vision, dental and domestic partners