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Medical Review Analyst

WellSpan Health • York, PA • 2h ago

Job Identification 228797

Job Category Revenue Cycle

Job Schedule Full time

Job Shift Shift1 - Day

Locations 3189 Farmtrail Rd, York, PA, 17406, US

Assignment Category Not Applicable

FTE 1

Job Description

Schedule

Full-Time: 40 Hours/Weekly

Mon - Friday Day Shift (8-4:30p)

General Summary

Supports clinical areas throughout the System in charge capture, coding accuracy and revenue management. Maintains the department's chargemaster, in conjunction with revenue management, including setting up charges, updating charges and auditing charges against medical documentation. Conducts reviews of departments to optimize reimbursement for the System while ensuring compliance with applicable laws and regulations.

Responsibilities

Essential Functions:

Consults with clinical departments on charge process. Ensures appropriate usage of billing mechanisms and process flow to optimize reimbursement through both coding and charge capture.

Conducts random reviews comparing medical record documentation to validate charge capture.

Identifies issues with medical necessity and coding that reduce reimbursement. Works with departments to improve the process.

Investigates and recommends action steps and works collaboratively with the department to improve processes when control, operational weaknesses and /or compliance issues are found. Performs follow up reviews to ensure action steps were met.

Ascertains compliance with established policies, plans and procedures as well as external regulations.

Investigates billing system errors as a result of potentially inappropriate documentation, coding, medical necessity or charging. Follows through with the department to ensure corrective action.

Investigates payers' denials and institutes appropriate course of action. Develop process improvement if internal review coincides with payer denials to ensure appropriate reimbursement.

Works with billing and ancillary departments to resolve billing edits and billing inquiries.

Works in conjunction with Financial Specialist when submitting for appeals for payer denials or requests for reduction in service.

Interfaces with physicians, managers and staff in departments to ensure quality work product..

Enters and/or retrieves data from established computer files using knowledge of various computer software applications.

Common Expectations:

Maintains established policies and procedures, objectives, quality assessment and safety standards.

Maintains professional growth and development.

Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Administers/coordinates programs, projects, and/or processes as assigned.

Qualifications

Minimum Education:

High School Diploma or GED Required or

Associates Degree Preferred or

Bachelors Degree Preferred

Work Experience:

3 years Related experience. Required

Courses and Training:

Certified Coder Upon Hire Preferred

Knowledge, Skills, and Abilities:

Excellent written and oral communication skills.

Basic computer skills.

Works effectively in a team environment.

Benefits Offered:

Comprehensive health benefits

Retirement savings plan

Paid time off (PTO)

Education assistance

Financial education and support, including DailyPay

Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org) (https://www.joinwellspan.org/benefits/)

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.

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