Financial & Reimbursement Consultant

GENESIS HEALTHCARE SYSTEM

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an 'owner' of Genesis and keep our patients at the center of everything we do - always.


Position Details:

Work Shift:
Day Shift (United States of America)

Scheduled Weekly Hours:
40

Department:
Payer Relations

Overview of Position:

Maintains accurate third party payer reimbursement modeling and contract maintenance systems. Verifies reporting from such systems in order to provide accurate, high quality information pertaining to contract management outcomes as needed for financial and other analysis Provides tracking and analysis of quality measures present in reimbursement contracts.
ESSENTIAL DUTIES
1. Tracks and analyzes system performance on contract requirements such as quality scorecards
2. Completes contract modeling, performance reporting, and maintenance within Epic
3. Performs investigation and analysis of assigned work queues within Epic.
4. Assists with new payer/plan build and design within Epic.
5. Negotiates payment on individual non-network cases.
6. Assists with third party payer reimbursement communications and is the liaison to all hospital departments and outside entities that have business with the Financial & Reimbursement Services department.
7. Provides support to the Managed Care team by converting data into information.
8. Supports all hospital departments with reimbursement methodology, contract language knowledge, and proper identification of third-party payers during registration.
9. Develops and maintains documentation and procedures, as needed, to provide training to other staff.
10. Functions as primary resource dedicated to designing, building, testing, and activating the contract management information systems. These include Epic Hospital Billing and any other contract management system.
11. Responsible for resolving Epic expected reimbursement system functionality issues via assigned Footprints tickets.
12. Documents and maintains all required contract management system design, build and change documents.
13. Contributes to testing of all contract management systems to ensure proper system configuration.
14. Works with all contract management system vendors to resolve issues/problems in a timely manner.
15. Effectively utilizes project tools, technologies and methodologies to provide clear and concise documentation/communication (i.e. project tracking, weekly reports, etc.).
16. Maintains open communications with functional area manager/director regarding projects and systems issues.
17. Prioritizes and schedules projects and resources.

QUALIFICATIONS
1. Bachelor's degree in Accounting, Business Administration, Healthcare, or related area or equivalent experience with reimbursement methodologies, contract language, and adjudication of claims.
2. Ability to read and write in order to understand, explain, or describe moderately complex information.
3. Strong verbal and written communication, problem solving and critical thinking skills.
4. Ability to independently prioritize and focus on multiple tasks concurrently.
5. Strong PC skills in Word, Excel, Lotus Notes, and Windows applications.
6. Appropriate EPIC certification to be obtained within provided timeline, if EPIC certifications are not already obtained.


PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS
1. Living the Genesis Mission, Vision and Values:
• Performs work in a manner that is quality focused.
• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.
• Results oriented and focused on achievement of objectives.
• Acknowledges and responds to the diversity of people and the situation.
• Encourages peers (others) to be owners of change.
• Always makes the effort to anticipate and exceed customer needs and expectations.
• Possesses the ability to engage others with patience and understanding.
• Acts in a manner that creates positive first and lasting impressions.
• Demonstrates the ability to own issues until they are resolved.
2. Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)
• Introduces self and role...connects with everyone.
• Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.
• Asks for and anticipates needs and concerns of others.
• Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)
• Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately.
• Responds to requests in an appropriate and timely manner.
• Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.
3. Promotes Patient and Employee Safety
• Demonstrates safe Patient Handling (i.e. transfers, transport, care administration, nutrition, medication, etc.)
• Demonstrates safe Materials Handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.)
• Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment
• Demonstrates Slips/Trips and Falls Awareness.
• Actively contributes to maintaining a safe, clean and quiet environment.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to operate a personal computer for 4 to 8 hours per day. Occasional prolonged standing and walking.
2. Ability to read print of various sizes.
3. Ability to work with detail and accuracy for prolonged periods.
4. Ability to utilize standard office equipment.
5. Ability to do some light lifting, stooping, and bending.

This description reflects in general terms the type and level of work performed. It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.


Thank you for your interest in employment at Genesis. Genesis is committed to being an equal opportunity employer. Selection of applicants for employment is based only on qualifications and the requirements of a specific job.