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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
Participates in any or all aspects of the claim submission to third party carriers, incorporating industry best practices to ensure all state and federal billing guidelines and regulations are satisfied. Conducts root cause analysis of claim edits to determine corrective action to facilitate timely submission of claims and enhance the clean claim rate.
Job Duties
- Analyzes claim edits and conducts root cause analysis to resolve the edit, identifying opportunities for work flow process improvement and claim logic implementation to enhance the clean claim rate.
- Monitors claim rejections from insurance carriers, taking the corrective action necessary to resubmit the claim, escalating rejection trends to department leadership for the creation or modification of claim edits, claim rules, or for escalation to the provider rep.
- Maintains working knowledge of all regulatory claim form requirements, coding rules, LVHN protocols, as well as being proficient in all payer specific billing requirements.
- Participates in claim rebill projects to address updates to items such as payer contract modifications, CDM updates, correction to charge errors, and coding version changes.
- Maintains a positive and productive relationship with other LVHN Revenue Cycle Departments, instituting best practices to reinforce workflow standardization and optimize productivity.
- Processes late or corrected charges according to billing guidelines for payers, submitting late replacement claims, corrected claims, or processing late charge write-offs.
- Compiles documentation necessary for submission of paper claims: claim attachments, investigation of payer address, claim number; resolves eligibility situations, when necessary.
Minimum Qualifications
- High School Diploma/GED
- 2 years of professional or facility billing and/or collections for all major third party payers or work experience in healthcare related field.
- Knowledge of third party reimbursement.
- Knowledge of insurance contracts and regulations.
- Must maintain high-level knowledge of claim submission requirements.
- Strong analytical, mathematical, and organizational skills.
- Experience working with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
- Successful completion of DOE and Revenue Cycle Education within 3 months of hire.
Preferred Qualifications
- Associate’s Degree Healthcare Administration, Finance or Business or
- CPAT - Certified Patient Accounting Technician - State of Pennsylvania
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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