Medical Review Analyst - York - (full-time) - Days

York, PA | Professional | Tracking Code: 52244

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General Summary:

 

 

 

Under the general supervision of the Director-Revenue Management, supports clinical areas throughout the System in charge capture, coding accuracy and revenue management. Conducts reviews of departments to optimize reimbursement for the System while ensuring compliance with applicable laws and regulations.

 

 

Duties and Responsibilities:

 

   1   Consults with clinical departments throughout the System on charge process. Ensures appropriate usage of charge

       vouchers to optimize reimbursement through both coding and charge capture.

   2   Conducts random reviews comparing medical record documentation to validate charge capture, medical necessity and

       coding accuracy.

   3   Investigates and recommends action steps and works collaboratively with the department to improve processes when

       control, operational weaknesses and/or compliance issues are found. Performs follow up reviews to ensure action

       steps were met.

   4   Ascertains compliance with established policies, plans and procedures as well as external regulations.

   5   Investigates billing system errors as a result of potentially inappropriate documentation, coding, medical necessity or

       charging. Follows through with the department to ensure corrective action.

   6   Investigates payers’ denials and institutes appropriate course of action.   Develop process improvement if internal

       review coincides with payer denials to ensure appropriate reimbursement.

   7   Interfaces with physicians, managers and staff in departments to ensure quality work product.

   8   Assists in special revenue management projects.

Required Experience

Minimum Education:              

 

Bachelor's Degree

                                            

 

Minimum Experience:           

 

3 - 5 years

                                            

 

Preferred Certification/Registration:          

 

Registered Nurse or Certified Coder


Quality of Life

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,200 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, six respected hospitals, more than 15,000 employees, and 140 patient care locations. WellSpan is a charitable, mission-driven organization, committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Quality of Life
Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

Equal Opportunity Employment

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

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