Job Summary

We are seeking a detail-oriented professional with strong healthcare billing and claims experience to join our team. The successful candidate will be responsible for reviewing provider contracts to ensure accurate coding and proper setup of payment terms within the claims processing module. This role also involves contributing to special projects focused on implementing industry-standard or government-mandated coding changes that impact provider payments. Ideal candidates will bring a solid understanding of CMS1500 and UB04 claim forms, CPT/HCPC codes, Revenue codes, and ICD-10 coding, along with excellent analytical and organizational skills.

Job Duties

​Assists with ongoing configuration, management and oversight in Facets or other systems related to Benefits, Finance, Pricing, Billing and Dunning, Consumer Driven, Provider set up, Claims and Workflow and other areas of configuration and operations. Assists in the configuration and management of specified programs, products and services in one or more of the major areas within configuration. Helps ensure continued operational functionality and accuracy of the Facets system and supporting systems that will in turn lead to membership retention and growth and member,  provider and broker satisfaction.

• Reviews and interprets benefit documents to configure benefits at all levels of detail.
• Designs, configures and tests benefits according to Health Plan and industry coding schemes, resolves issues and communicates resolutions
• Manages the creation of member ID cards and member benefit documents.
• Responsible for all aspects of Finance Configuration including but not limited to, vendor capitation, group set up, premium rate tables, broker fees and commission schedules.
• Responsible for the timely generation and accuracy of premium billing invoices for members and employer groups and managing the dunning process.
• Initiates proper financial terms and accurate set up of contractual arrangements in the pricing module, assuring that requests conform to defined standards
• Interfaces with Provider Network Management and Contract Administration to ensure proper interpretation of unclear, unstated or obscure scenarios found in provider contracts and pricing agreements.
• Develops appropriate communication methods and standards for dissemination of pricing configuration information for new, modified, enhanced or fixed pricing agreements.
• Creates and supports the processes that allow correct provider set up and maintenance.
• Designs, creates, manages and issues resolution of Workflow rules that allow for automation of claims processing.
• Configures the eligibility process, the configuration migration utility process, letter generation and configuration support for consumer driven products.
• Partners with other teams to help resolve questions, concerns and issues for new or updated configuration needs.
• Trains other team members on configuration policies and procedures and maintaining appropriate documentation to support all changes, assisting in audit processes of configuration with both internal and external audit vendors.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

*Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

#LI-REMOTE

Position Details

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 4 years-Relevant experience* (Required)

Certification(s) and License(s)

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.

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