Health Information Management Coding and Revenue Analyst

Eisenhower Health•Rancho Mirage, CA

1d•$31 - $46

About The Position

Ensures the accuracy, integrity, and compliance of coded health system encounters across inpatient and outpatient settings, including outpatient surgery, emergency, and observation. Conducts retrospective audits, validates code assignment and charges where appropriate, and evaluates adequacy in alignment with organizational policies. Serves as an HIM Epic and 3M-360 Super-user.

Requirements

Associate’s degree in Health Information Management or a related field.
Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) credential from the American Health Information Management Association (AHIMA).
Two years of experience in hospital or facility coding and charge capture as a certified coder.
Ability to adapt quickly to changing priorities and unexpected situations.
Ability to create and maintain positive interpersonal relations with peers, staff, leaders, and vendors.
Ability to investigate and analyze multiple coding resources, including Coding Clinic, CPT Assistant, coding and charging for devices and implants, Local/National coverage determinations, and payer contracts.
Expert knowledge of the 3M encoder and related products.
Expert-level working knowledge of inpatient and outpatient coding guidelines, including ICD-10-CM/PCS and CPT.
Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, charging, and billing.
Extensive working knowledge of revenue cycle workflows, charging, revenue integrity, and hospital accounting principles.
Proficiency with Microsoft Office applications and advanced working knowledge of Excel.
Working knowledge of Epic workflows pertinent to HIM, coding, and revenue cycle.
Written and verbal communication skills.

Nice To Haves

Bachelor’s degree in Health Information Management or a related field.
Epic certification in coding.
Formal auditing, consulting, or vendor experience.
Experience using 3M-360.
Experience with hospital charging and revenue cycle initiatives.

Responsibilities

Demonstrates compliance with the Code of Conduct and compliance policies; takes action to resolve compliance questions or concerns and report suspected violations.
Works closely with the HIM Director and Managers to support revenue cycle initiatives, including denials and appeals.
Performs routine and targeted audits of inpatient and outpatient (OPPS/APC) encounters; assists with work queue management and troubleshooting account routing issues.
Validates diagnosis, procedure, or modifier assignment and confirms accurate DRG/APR-DRG/HCC/APC capture as applicable.
Communicates with vendors daily, manages Epic work queues/DNFC, investigates and completes coding updates and corrections, and coordinates appeals, denials, and rebills.
Reviews documentation for completeness, specificity, and consistency; identifies query opportunities and documentation gaps.
Applies editing logic (NCCI, MUEs) and client or organizational standards to assess compliance.
Supports denials management workflows, including work queue management, tracking, and ensuring timely appeal responses.
Supports 3M-360 initiatives, including reporting and analytics, and supports system enhancements and upgrades in testing and production environments.
Interacts with organizational leaders, medical staff, Clinical Documentation Improvement, Hospital and Clinic Billing offices, and others needing HIM coding support.
Supports HIM’s role in coordinating appeals, denials, payer and RAC audits, rebills, and hospital-acquired conditions (HAC), including reviewing and analyzing payer and regulatory communications, performing chart review and account analysis, making appropriate recommendations, and communicating with third parties and payers regarding coding issues.
Supports California state reporting, including data validation, correction, and submission within regulatory requirements.
Coordinates onboarding and off-boarding of vendor staff.
Maintains current AHIMA credentials and certifications and performs work duties in accordance with the AHIMA Code of Ethics.
Performs special projects and supports HIM and revenue cycle initiatives as needed.
Performs other duties as assigned.