Imagine a career at one of the nation's most advanced health networks.
Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.
LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.
Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.
SummaryWorks collaboratively with department leadership to review and manage open AR accurately documenting follow up activities resulting in the resolution of underpayments and denials. Works claim edit work queues to review, correct or adjust claims prior to being sent to insurance to reduce denials and increase reimbursement. Conducts root cause analysis of denials and takes the action necessary to resolve the denial escalating accounts to management that need additional action. Identifies claim edit, denial, underpayment and correspondence trends that require computer system modifications. Prepares reports for meeting with provider representative and senior leadership as required.
Job Duties
- Demonstrates knowledge of insurance carrier reimbursement requirement to evaluate underpayment/denials related to insurance carrier clinical and payment policies.
- Works collaboratively with management to establish issue logs, account examples and reporting for meetings with insurance. Participates in monthly meetings with insurance provider representative meetings to escalate claims for resolution and payment.
- Organize, prioritize and analyze correspondence for all payors - reporting to Supervisor trending issues.
- Proficient in EPIC workflows in claim edits, insurance follow up and account work queues.
- Identifies and reports problems which may compromise service, quality, safety and/or organization performance.
- Assures all work queues remain current and accurate to order to meet monthly productivity and quality.
- Remains current regarding payer trends, policies, and financial matters as they pertain to follow up and billing in PFS.
Minimum Qualifications- High School Diploma/GED
- 5 years Professional billing an/or collections for all major third party payers.
- Microsoft Excel intermediate skills.
- Knowledge of insurance contracts, regulations, and interpersonal and problem-solving skills.
- Knowledge of utilizing resources available.
- Strong analytical, mathematical, and organizational skills.
- Knowledge of basic medical terminology.
- Knowledge of professional billing practices.
- Microsoft office applications.
Preferred Qualifications- Associate’s Degree or
- Specialized Diploma Revenue Cycle or Billing
Physical DemandsLift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.
Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.
Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.
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