Manager Program Integrity (certified professional coder), Geisinger Health Plan (Work from home United States)
Location: Harrisburg, Pennsylvania
Type: Full Time
Internal Number: R-39600
Manages day to day operations of Program Integrity Department. Ensures compliance with all federal, state, and other regulations while maintaining the integrity of all auditing data and reports. Conducts periodic compliance and performance reviews of auditor cases and activity. Improves the balance of complexity versus-value to increase potential impact and returns. Successfully promotes and ensures audits are fact based, unbiased, comprehensive, and provides comprehensive informative findings.
Guides others to develop build and update work plans, tasks, timelines, measurements, and reports.
Negotiates settlements and oversees vendor relationships and deliverables that support corporate business decisions.
Compiles and presents summaries of complex audit activities in a professional format to the appropriate internal or external entities.
Prioritizes and manages audits to achieve savings, pursue overpayment recoveries and changes in behavior.
Conducts periodic compliance and performance reviews of auditor cases and activity.
Participates in and coordinates Provider Appeals process specific to overpayment demands.
Designs and implements wide-ranging, global programs.
Organizes and develops initiatives across the enterprise which respond to change in managed care.
Prioritizes time-sensitive requests and meet urgent and tight deadlines.
Act as a resource on compliance issues or questions related to auditing and monitoring activities.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
*Relevant experience may be a combination of related work experience and degree obtained (Associate's Degree = 2 years; Bachelor's Degree = 4 years).
High School Diploma or Equivalent (GED)- (Required)
Minimum of 9 years-Relevant experience* (Required), Minimum of 2 years-Managerial/Supervisory (Required)
Certification(s) and License(s)
Certified Professional Coder - American Academy of Professional Coders (AAPC)
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 1...3 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.