Imagine a career at one of the nation's most advanced health networks.

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
Works with all clinical audit teams, compliance department, and specific departments to maintain an organized and timely logging, gathering of documentation, tracking, and follow-up of all audits including recovery audit contractor and any third-party request activities. Follow-up and support data, manages the data and organization, and administrative needs to all clinical audit teams to help with reporting of data and identifying trends.

Job DutiesAnalyze data of requested claims and applies critical analytic thinking to identify pre and post-pay audit trends and claim denial trends by facility location, payers, and services lines to prepare reports to reflect RAC audits, insurance, and third-party activities and claim denials. Logs all audit and claim denial requests, review findings, and determinations into the audit and tracking data base and evaluate logging and tracking processes and log all claim denials. Identify workflow road blocks and makes recommendations to management and software vendor. Develops and maintains a productive client, staff, and management relationships through individual contacts, events, and group meetings. Communicate the results of audit activities via written report and oral presentation to management. Completes follow-up and closing of audits. Creates educational materials on use of audit tracking software and provides ongoing training to staff. Works, reviews, and files all mail coming in via fax/scanning/e-mail and assign to most appropriate work queues for the Audit Compliance and Data Coordinator team to work. Coordinators sending of appeals via RightFax while creating a database of all appeals sent. Assist clinical audit and follow-up teams with write-offs and assigned to management work queue. Attend monthly insurance/payer vendor meetings to ensure up to date information on policy updates/billing updates/etc. Maintains open communication with insurance/vendor representatives.
Minimum QualificationsHigh School Diploma/GED 3 years 3 years in a hospital or healthcare administrative secretarial or office management enviroment Ability to handle multiple tasks, deadlines, and requests utilizing appropriate time-management skills. Ability to organize and conduct effective reporting and communication to assist management in the analysis of RAC and other third-party request activities. Computer skills and working knowledge of Microsoft Office and other computer-based applications in order to create and maintain spreadsheets, databases, and perform word processing functions. Extensive skill in planning and maintaining composure under pressure while meeting multiple deadlines. Skill in compiling, summarizing, and analyzing complex data, and evaluating information and drawing logical conclusions.
Preferred QualificationsAssociate’s Degree
Physical Demands
Lift and carry 7 lbs., continuous sitting >67%, frequent keyboard use/repetitive motion, frequent fine motor activity/wrist position deviation.

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.

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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.

Work Shift:

Day Shift

Address:

2100 Mack Blvd

Primary Location:

Mack Building

Position Type:

Onsite

Union:

Not Applicable

Work Schedule:

Monday-Friday; 8:00a-4:30p

Department:

1004-13060 CSS-Clinical Appeals - Denial Mgmt