Revenue Cycle Analyst/Coder

Eisenhower Health•Rancho Mirage, CA

5d•$24 - $36•Onsite

About The Position

Responsible for performing revenue cycle integrity audits within the Charge Descriptive Master and other revenue cycle charge capture and reconciliation processes. This role involves auditing revenue-generating departments' CDM files, conducting interviews to ensure proper recording of transactions and compliance with state and federal coding guidelines. The analyst will provide guidance and education to staff on correct charge capture, billing, and coding processes, and prepare audit findings and recommendations for leadership. Additionally, the role assesses the accuracy of charge capture tools, reviews facility bill rejection reports, and makes recommendations regarding control deficiencies, duplication of effort, fraud, or lack of compliance. The analyst will also assist departments with bill rejection charges, maximize collections by understanding payor contracts, and act as a liaison between various teams to ensure charge structures and rates are consistent with regulatory standards and market conditions. Engagement in process improvement initiatives is also a key aspect of this position.

Requirements

High school diploma, GED or higher level degree if hired after March 1, 2025
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) within one (1) year if hired into position after January 1, 2021
Two (2) years of medical billing, charge capture, coding or patient account auditing experience
Ability to analyze issues, identify root causes, and develop solutions
Ability to create and maintain positive interpersonal relations with peers, staff, leaders and vendors
Ability to integrate the financial, clinical and coding processes to improve compliance and maximize reimbursement
Ability to take initiative by identifying problems, conceptualizing resolutions to the problems and promote to the appropriate infrastructures for review
PC application proficient with for financial analysis, data base, report generator; working knowledge of financial statements and ability to analyze financial information and determine financial impact of possible changes
Research skills with various published resources and Internet access to associated information resources
Solid understanding of the charge capture work flows and methodologies used in billing and collection processes
Written and verbal communication skills

Nice To Haves

Medical coding coursework or bachelor’s degree in related field
Revenue cycle experience
Hospital/clinical experience

Responsibilities

Performs audits of all revenue generating departments’ CDM files.
Conducts departmental interviews to ensure proper recording of transactions and compliance with state and federal coding guidelines relating to the charge capture and billing of services.
Provides guidance, communication and education to department and clinic staff on correct charge capture, current charging structure, billing and coding processes by the elimination of duplicate, inactive or non-compliant charges incorporating state and federal guidelines.
Prepares and submits audit findings to leadership to review and compile recommendations.
Assesses the accuracy of charge capture tools (i.e. forms, charge screens, charge stickers and other charge capture tools) and recommends appropriate changes to meet these standards.
Reviews facility bill rejection reports to correct, edit or apply appropriate modifiers to charges for compliant billing practices, as appropriate.
Examines reports, and makes recommendations regarding deficiencies in controls, duplication of effort, fraud, or lack of compliance to leadership.
Provides assistance to all hospital department charge custodians to assist in completing their department identified bill rejection charges.
Maximizes collection through recognition of terms and conditions of EMC’s payor contracts. To present recommendations to Director of Payor Relations regarding terms and conditions and charge increases with consideration of improving payments from third party payors.
Acts as liaison between Revenue Recognition team, Charge Master, Payor Relations and PFS to assist revenue generating department leadership in the establishment and periodical review of charge structures and charge rates to be consistent with all regulatory and compliance standards, regional and local market shares and EMC contracts.
Assists leadership in identifying areas of process improvement, system enhancement and actively engages in a process improvement committee representing the role in any integrated hospital process improvement team.
Performs other duties as assigned.
Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.