Senior Payer Relations - Revenue Compliance & Recovery Specialist

Imagine a career at one of the nation's 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. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's 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 LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're 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

• Bachelor’s 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

• Master’s 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 employer. In 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