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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.
Summary
Works closely with Supervisor and Manager of Clinical Denials Audit and maintains an organized and timely process for the logging, tracking and follow up of the Recovery Audit Contractor (RAC), other third-party request activities, and clinical denials. Prepares monthly reports for management team and ad hoc reports as requested. Maintains and updates workflow processes and policies as needed. Establishes and coordinates orientation and educational materials for new staff and other departments. Monitor and report timely worklist responses to appropriate manager. Follow-up and support data, manages the data and organization, and administrative needs to all clinical audit teams to help with reporting of data and identifying trends.
Job Duties
- Works closely with the Supervisor and Manager of Clinical Denials Audit and maintains an organized and timely process for the logging, tracking and follow up of the Recovery Audit Contractor (RAC), other third-party request activities, and clinical denials.
- Prepares monthly reports for management team and ad hoc reports as requested.
- Maintains and updates workflow processes and policies as needed. Establishes and coordinates orientation and educational materials for new staff and other departments.
- Monitor and report timely worklist responses to appropriate manager.
- Follow-up and support data, manages the data and organization, and administrative needs to all clinical audit teams to help with reporting of data and identifying trends.
Minimum Qualifications
- High School Diploma/GED
- 5 years in a hospital or healthcare administrative secretarial or office management environment.
- Work requires the ability to organize and accomplish objectives through the managers and staff outside of formal organizational authority.
- Requires the ability to organize and conduct effective reporting and communication to assist management in the analysis of RAC and other third-party request activities
- Skill in compiling, summarizing, and analyzing complex data, evaluating information, and drawing logical conclusions.
- Excellent interpersonal skills to work with team members, internal and external customers, including strong written communication skills.
- Ability to handle multiple tasks, deadlines, and requests utilizing appropriate time-management skills
- Assist with the coordination, implementation and monitoring of RAC and third-party request activities and clinical denials .
- Computer skills and working knowledge of Microsoft Office and other computer-based application in order to create
Preferred Qualifications
- Associate’s Degree
- 2 years
- Efficient with power points and advance report capabilities with Microsoft office software
- Have working knowledge and set up of audit software used for tracking and reporting of pre and post pay audits and clinical denials.
Physical Demands
Lift 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.
Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.
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