Payer Policy Coordinator (Full Time)
LOCATION: Lititz, PA
SHIFT: Full Time position with flexible hours and WFH possibility.
POSITION SUMMARY: Provides ongoing review and analysis of payer policies for both technical and professional billing, as well as clinical and pharmaceutical updates. Communicates all necessary policy changes to the appropriate personnel/departments.
ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:
- Performs the ongoing analysis of payer policies and processes associated with professional and hospital billing; this includes clinical and pharmaceutical updates.
- Communicates all relevant insurance carrier policies (new and updated) that impact professional and hospital operations. (May include communication to affiliated entities: Home health, LBHH, Private practices)
- Provides assistance to Revenue Cycle personnel with respect to payer policy interpretation, problem solving, and troubleshooting the application as necessary.
- Coordinates and facilitates project meetings, prepare status reports, and supports operations personnel with interpretation and implementation payer policies.
- Routinely prioritizes policy review based on significance of payer to the organization’s revenue cycle or the financial impact to the organization. Elevate critical policies (new or updated) to the appropriate personnel.
- Attends Insurance Carrier Provider representative meetings, addressing issues in policies, inappropriate coding/clinical references, and assisting in interpretation of associated policies involving denial/appeals.
SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:
- Coordinates with Corporate Managed Care team that also performs payer policy reviews.
- Maintains strong project management skills. Stays current on technology, project management skills, processes and implementation methods.
- Promotes team building and communication for project teams.
- Provides additional project support in other areas of the organization as directed.
- Other duties as assigned
MINIMUM REQUIRED QUALIFICATIONS:
- Bachelor’s degree. Extensive experience may substitute for education.
- Five years of healthcare experience in either revenue cycle, clinical field with exposure to authorization requirements, or insurance company operations in related healthcare workflows such as utilization management, provider representative, or claims.
- Knowledge and experience working with data analysis tools, patient accounting systems and office programs
- Excellent verbal and written communication skills.
- Prior experience with interpreting or implementing payer policies.
- Technical or professional coding experience and/or current coding certificate such as: Registered Health Information Administrator (RHIA), Hospital Coding Certificate (CCS), other coding certificates (e.g. RHIT, CCS-P, CPC, CPC-H COC, CPMA).
- Ten (10) years’ experience in a healthcare organization or health insurance carrier.
Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely.
PENN MEDICINE LANCASTER GENERAL HEALTH offers the following benefits to employees:
- 100% Tuition Assistance at The Pennsylvania College of Health Sciences
- Paid Time Off and Paid Holidays
- Shift, Weekend and On-Call Differentials
- Health, Dental and Vision Coverage
- Short-Term and Long-Term Disability
- Retirement Savings Account with Company Matching
- Child Care Subsidies
- Onsite Gym and Fitness Classes
Posted on 04/25/2022
PENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.
Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.