Medical Review Specialist

Job TitleSupports clinical areas throughout the System in charge capture, coding accuracy and revenue management.Job DescriptionFull-Time: 40 Hours/WeeklyMon - Friday Day Shift (8-4:30p)ResponsibilitiesEssential 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.QualificationsMinimum Education:High School Diploma or GED Required orAssociates Degree Preferred orBachelors Degree PreferredWork Experience:3 years Related experience. RequiredCourses and Training:Certified Coder Upon Hire PreferredKnowledge, Skills, and Abilities:Excellent written and oral communication skills.Basic computer skills.Works effectively in a team environment.Benefits Offered:Comprehensive health benefitsRetirement savings planPaid time off (PTO)Education assistanceFinancial education and support, including DailyPayExpanded Paid Parental LeaveAbout UsWellSpan Health's vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region's largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest. WellSpan Health