Audit Clinical Data Coordinator

Job not on LinkedIn

🔥 18 hours ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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👻 Ghost score 10%

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Lehigh Valley Health Network

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Lehigh Valley Health Network is a comprehensive healthcare system that is now part of Jefferson Health, one of the top 15 not-for-profit health systems in the United States. It offers a wide range of medical services, including primary care, urgent care, and specialized institutes like the Lehigh Valley Topper Cancer Institute and the Lehigh Valley Heart and Vascular Institute. LVHN provides extensive care solutions, including video visits, second opinions, and a network of doctors and clinicians in numerous locations. It emphasizes education through residencies and fellowships and prioritizes patient-centric services such as lab testing and women's health care. The network also focuses on innovation, offering clinical trials and advanced therapies like CAR-T Cell Therapy.

📋 Description

• Analyze requested claims data to identify pre- and post-pay audit trends and claim denial trends by facility location, payers, and service lines • Prepare reports reflecting RAC audits, insurance, third-party activities, and claim denials • Log audit and claim denial requests, review findings and determinations, and evaluate logging and tracking processes • Identify workflow roadblocks and make recommendations to management and the software vendor • Develop and maintain relationships with clients, staff, management, and insurance/vendor representatives • Communicate audit activity results through written reports and oral presentations to management • Complete audit follow-up and closure • Create educational materials for audit tracking software and provide ongoing staff training • Review and file mail received via fax, scanning, and email, assigning it to appropriate work queues • Coordinate appeals sent via RightFax and maintain a database of appeals • Assist clinical audit and follow-up teams with write-offs and management work queues • Attend monthly insurance/payer vendor meetings to stay current on policy and billing updates

🎯 Requirements

• High School Diploma/GED • 3 years in a hospital or healthcare administrative secretarial or office management environment • Ability to handle multiple tasks, deadlines, and requests utilizing appropriate time-management skills • Ability to organize and conduct effective reporting and communication to assist management in the analysis of RAC and other third-party request activities • Computer skills and working knowledge of Microsoft Office and other computer-based applications to create and maintain spreadsheets, databases, and perform word processing functions • Extensive skill in planning and maintaining composure under pressure while meeting multiple deadlines • Skill in compiling, summarizing, and analyzing complex data, and evaluating information and drawing logical conclusions • Preferred: Associate’s Degree

🏖️ Benefits

• Equal opportunity employment policy • Day shift schedule • Monday-Friday work schedule, 8:00a-4:30p • Remote work in Pennsylvania