Department:Government Programs, Geisinger Health Plan
Work Type: Full Time
Assesses encounter data as a result of operational claim deficiencies, incorrect provider billing and core system configuration, electronic data management business rules and eligibility processes. This position will research, analyze, summarize and categorize all types of encounters based on multiple response files from the PA Department of Human Services (DHS), as appropriate. This position must work closely with DHS, internal departments and delegated vendors to monitor, resolve and prevent future encounter data errors.
COMPETENCIES AND SKILLS:
Demonstrated project management skills with the ability to work collaboratively to produce results across functional teams.
Ability to develop and track encounter error and resolution status reports.
Demonstrated research and analytical abilities.
Ability to judge severity of problems and the need to escalate to management.
Demonstrate ability to organize and prioritize work.
Demonstrated computer proficiency particularly with MS Office software.
Demonstrated ability to conduct detailed research of claims, system, reports, and similar required.
The specific statements shown above are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job
EDUCATION AND/OR EXPERIENCE:
Minimum 2 years claims adjudication experience with working knowledge of Government requirements or equivalent healthcare experience. Minimum of one-year direct healthcare encounter data experience strongly encouraged.
Bachelor's degree or equivalent experience in lieu of degree.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment. May require occasional evening and weekend work.
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.
GEISINGER HEALTH PLAN (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries.
About Geisinger: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.