Payer Process Coordinator - UR revenue cycle 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
This position supports Utilization Review revenue cycle.
Summary: Provides guidance, support, and oversight to ensure effective management of government regulations; commercial and non-commercial audits (RAC, MIC, etc.). Management and evaluation of data will be performed 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. Manage 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, provide administrative support to the Medical Director, Utilization Review, and the Physician Advisor team. Coordinate UR appeals process in collaboration with the appeals Outcomes Manager. Assess 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 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.
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