Senior Payer Relations Revenue Compliance & Recovery Specialist

Imagine a career at one of the nations 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. Were a Magnet(tm) Hospital having been honored five times with the American Nurses Credentialing Centers 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 LVHNs commitment to teamwork compassion and technology with an unrelenting focus on delivering the best health care possible every day.

Whether youre considering your next career move or your first you should consider Lehigh Valley Health Network.

Summary
Advances Payment Compliance functions to a fully integrated enterprise model. Utilizes Subject Matter Expertise to build a scalable process utilizing Epic technology. Maintains payer relationships to strengthen payer performance. Leverage Revenue Cycle expertise to ensures system wide contract compliance drive strategic resolution of underpaid claims audits payor performance and analyzes actual payments of payer. Monitors payer policies and assess their impact on the enterprise.

Job Duties

• Compares actual reimbursement to expected reimbursement across the enterprise. Reviews managed care contract terms claims billing details and clinical information to identify and reconcile underpaid accounts. Supports development of system-wide payment compliance workflows and methodologies.
• Builds relationships with payer representatives on behalf of the enterprise. Facilitates consistent information flow alignment and issue resolution ensuring payer performance transparency across the enterprise.
• Partners with Revenue Cycle Utilization Management and Operational Leaders to identify consolidate and escalate payer-related A/R trends. Uses institutional experience to drive action.
• Monitors interprets and analyzes payer policy changes and emerging industry regulations impacting the organization. Collaborates with data analytics clinical teams and operational partners to generate deep insights and develop strategies for engagement escalation and dispute management.
• Collaborates with stakeholders to build consistent scalable processes that support enterprise integration and promotes optimized reimbursement.

Minimum Qualifications

• Bachelors Degree
• 5 years progressive experience in billing health insurance physician practice or equivalent operations environment.
• Expert knowledge of health care reimbursement and contracting and the use of deductive reasoning negotiating skills and collaborative skills to uncover and recover payment discrepancy in a complex system.
• Computer skills familiarity with EMR word processing and Excel.
• Knowledge of medical billing practices.
• Knowledge of healthcare work processes for revenue cycle departments and divisions.
• Knowledge and thorough understanding of the revenue cycle process and how components fit together.
• Knowledge and understanding of reimbursement methodologies such as fee-for-service capitation and case rates.

Preferred Qualifications

• Masters Degree
• 1 year work experience with providers health plans members and vendors.

Physical Demands
Lift and carry 25 lbs. frequent sitting/standing frequent keyboard use *patient care providers may be required to perform activities specific to their role including kneeling bending squatting and performing CPR.

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 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.

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:

707 Hamilton St

Primary Location:

One City Center

Position Type:

Onsite

Union:

Not Applicable

Work Schedule:

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

Department:

CSS-Payer Relations