Payer Process Coordinator - UR revenue cycle

Virtua
United States, New Jersey, Pennsauken
Nov 14, 2024
At Virtua Health, we exist for one reason - to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between - we are your partner in health devoted to building a healthier community.If you live or work in South Jersey, exceptional care is all around. Our medical and surgical experts are among the best in the country. We assembled more than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked by U.S. News and World Report, we've received multiple awards for quality, safety, and outstanding work environment.In addition to five hospitals, seven emergency departments, seven urgent care centers, and more than 280 otherlocations, we're committed to the well-being of the community. That means bringing life-changing resources and health services directly into our communities through ourEat Well food access program, telehealth, home health, rehabilitation, mobile screenings, paramedic programs, and convenient online scheduling. We're also affiliated with Penn Medicine for cancer and neurosciences, and the Children's Hospital of Philadelphia for pediatrics. Location: Pennsauken - 6991 North Park Dr. Employment Type: Employee Employment Classification: Regular Time Type: Full time Work Shift: 1st Shift (United States of America) Total Weekly Hours: 40 Additional Locations: Job Information: This position to support Utilization Reviewrevenue cycle. Summary: Provides guidance, support, and oversight to ensure effective management of government regulations; commercial and non-commercial and audits (RAC,MIC, etc.). Management and evaluation of data will be performed in order to track and measure the effectiveness of responses. New initiatives will be reviewed and a business process instituted. Position Responsibilities: Coordinate and support Recovery Audits for government (non-commercial) and commercial payer programs. Manages response process, legal process, and work with other areas for best practice. Evaluate data reporting to committee/management on a regular basis. Within Utilization Review, provides administrative support to the Medical Director, Utilization Review and the Physician Advisor team. Coordinates UR appeals process in collaboration with the appeals Outcomes Manager. Assess the denied claims due to inadequate linkage of diagnosis and procedure codes. Compile reports, monitor trends and, work with applicable departmental leaders to decrease denials. Report results and trends. Review the bundling/unbundling of CPT/HCPCS codes using the correct coding initiative and outpatient claim edits. Measure trends and work with areas to decrease edits. Report results and trends. Within patient accounting, review the bundling/unbundling of CPT/HCPCS codes using the correct coding initiative and outpatient claim edits. Measure trends and work with areas to decrease edits. Report results and trends. Complete and coordinate reports as necessary, i.e. Medicare Bad Debt, Charity Care Cost, Commercial Payor, and Non-Commercial Payor reports Coordinate policies and procedures on an ongoing basis in connection with compliance with Federal/State regulations related to the audits process, findings, fraud, cert letters, and new initiatives. Member of committees, six sigma teams, and all such teams in order to promote, communicate, and protect the compliance and financial viability of our organization. Position Qualifications Required / Experience Required: Five years' experience in Medicare/Medicaid billing regulations. Must have working knowledge of MS Office software and Medicare Fiscal Intermediary system. One year of Epic system experience highly preferred. Excellent organizational, analytical, and problem solving skills. Ability to work independently. Required Education: Undergraduate degree preferred, which can be substituted by sufficient experience.