Senior Medical Review Analyst

Ephrata, PA | Professional | Tracking Code: 55469

Position Summary:

General Summary:
Under the general supervision of the Director-Corporate Compliance & Revenue Management, supports clinical areas throughout the System in charge capture, coding accuracy and revenue management. Maintains the hospitals chargemasters, including setting up charges, updating charges and auditing charges against medical documentation. 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.
3 Identifies issues with medical necessity and coding that reduce reimbursement. Works with departments to improve the process.
4 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.
5 Ascertains compliance with established policies, plans and procedures as well as external regulations.
6 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.
7 Investigates payors denials and institutes appropriate course of action. Works with billing and ancillary departments to resolve billing edits and billing inquiries.
8 Oversees Financial Analysis Clerks when performing appeals for payor denials.
9 Interfaces with physicians, managers and staff in departments to ensure quality work product.
10 Assists in special revenue management projects.

 

Required Skills

Bachelor Degree

5 plus years of experience. Ideal applicants have extensive medical coding experience.

Pref Cert/Registration  Certified Coder

Potential to work remotely on a weekly basses.

 


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

Lancaster City was the capital of Pennsylvania from 1799 to 1812. Today, Lancaster County includes a vibrant downtown business district, desirable suburban neighborhoods and sprawling agricultural farms. Life in Lancaster County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, an independent professional baseball team, fine dining and more. When visiting Lancaster, one can't help but recognizing the influence of the Pennsylvania Dutch — farm-to-table and beyond.

Conveniently located in southcentral Pennsylvania, Lancaster is within an easy commute to major cities and has ready access to public transportation. Residents can find local employment in healthcare, tourism, public administration, manufacturing, and both professional and semi-professional services. (Patient population: 535,000)

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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