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The Practice Consultant (PC) acts as a consultant and clinical subject matter expert on clinical charge capture strategy and workflow, reimbursement, and regulatory policy for their identified clinical area. Provides strategic direction to facilitate maximization of clinical revenue and oversees activities associated with assigned clinical areas. Investigates current processes, assessing efficiency and accuracy, and provides solutions for problems and process improvement.
Acts as the subject matter expert for their assigned clinical areas to the broader Revenue Management team
Interacts with staff to optimize productivity and efficiency
Analyzes and reports on any findings related to performance indicators for their clinical areas
Advise staff on proper procedures related to use of systems and clinical tools (charge entry screens, charge router, orders, documentation templates, encounter types, work queues etc.)
Performs process analysis and identifies and/or participates in Revenue Integrity process improvement
Owns assigned clinical area's accounts in relevant work queues to ensure they stay current while identifying trends and issues to evaluate for system process improvements.
Works in conjunction with applicable team to monitor, react, and make necessary updates for hospital-based revenue routing accuracy.
Engage with professional and hospital billing teams on denial activity to identify trends and formulate plans on how to decrease and or prevent denials.
Review and analyze write off activity to identify trends and formulate plans on how to decrease and / or prevent write offs.
Identify, submit, follow through on issues or process improvements found within the billing system workflows.
Monitors and communicates information regarding commercial payer policy and regulatory policy changes, identifies the effect these changes have on the department and the clinical enterprise, and works with stakeholders to develop compliant remediation strategies.
Reviews KPI performance data including but not limited to charging, denials, lag days, etc. and identify areas of opportunity.
Prepares reports and/or presentations to communicate performance metrics and potential opportunities for the assigned clinical service line.
Collaborates with other departments on items including but not limited to new service auditing and general reconciliation activities.
Work is typically performed in an office environment. Travel may be required. 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.
Prefer Resolute application experience, Revenue Management experience, or clinical background
High School Diploma or Equivalent (GED)- (Required)
Minimum of 6 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.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, 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 sequencingprograms, 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 1...3 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.