Medical Review Analyst - Diagnostics - Part Time Location: WellSpan Health, York, PA Schedule: Part Time Hours: M-F Day Part Time: 20 hours per week General Summary Supports clinical areas throughout the System in charge capture, coding accuracy and revenue management. Maintains the department's chargemaster, in conjunction with revenue management, including setting up charges, updating charges and auditing charges against medical documentation. Conducts reviews of departments to optimize reimbursement for the System while ensuring compliance with applicable laws and regulations. Essential 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. Qualifications Minimum Education: + High School Diploma/GED required. + Associates or Bachelors preferred. Work Experience: + 3 years Related experience in billing/coding + This is a outpatient coding position + Must have experience in Healthcare + Prefer experience in imaging coding/billing Courses and Training: + Certified Coder Upon Hire Preferred + CPC-A, CPC, CCS-P, CCA certifications would be a major plus Knowledge, Skills, and Abilities: + Excellent written and oral communication skills. + Basic computer skills. + Works effectively in a team environment. Apply Now You’re unique and you belong here. At WellSpan Health, we are committed to treating all applicants fairly and equitably, regardless of their job classification. If you require assistance or accommodation due to a disability, please reach out to us via email atcareers@wellspan.org. We will evaluate requests for accommodation on a case-by-case basis. Please note that we will only respond to inquiries related to reasonable accommodation from this email address. Rest assured, all requests for assistance or accommodation are handled confidentially, allowing applicants to share their needs openly and honestly with us. WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.