Health Information Management Coding and Revenue Analyst

eisenhower; United States; On-site; USD 41,000 - 63,000; Full time

Job summary

Eisenhower is seeking a Health Information Management coder in the Medical Records department. The role requires CCS/RHIT/RHIA credentials, two years of hospital coding experience, and expertise with 3M-encoder, Epic workflows, and ICD-10-CM/PCS and CPT guidelines.

The position is full-time in the United States with standard 40-hour weeks. Daily duties include auditing, validation of diagnoses and procedures, and coordinating with vendors and payers to support revenue cycle initiatives.

Qualifications

• Requires an Associate's degree in Health Information Management or related field.
• Bachelor's degree in Health Information Management or related field preferred.

Responsibilities

• Demonstrates compliance with Code of Conduct and compliance policies.
• Supports denials management and appeals workflows.
• Performs routine audits of inpatient and outpatient encounters and ensures accurate coding and charge capture.
• Interacts with vendors and manages Epic work queues and updates coding corrections.

Skills

Adaptability

Interpersonal skills

Coding resources

3M encoder proficiency

ICD-10-CM/PCS and CPT

Regulatory compliance

Revenue cycle understanding

Excel proficiency

Epic workflows

Education

Associate's degree in Health Information Management or related field

Bachelor's degree in Health Information Management or related field

Tools

3M-360

Epic

CPT Assistant

Job description

Default Work Shift

Day (United States of America)

Hours

40

Salary range

$30.59 - $46.48

Schedule

Full Time

Shift Hours

8 Hour employee

Department

Medical Records

Job Objective

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, validates charges where appropriate, and evaluates adequacy in alignment with organizational policies. Serves as an HIM Epic and 3M-360 Super-user.

Job Description

Education:

• Required: Associate's degree in Health Information Management or related field
• Preferred: Bachelor's degree in Health Information Management or related field

Licensure/Certification

• Required: Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) from American Health Information Management Association (AHIMA)
• Preferred: Epic certification in coding

Experience

• Required: Two (2) years of experience in hospital/facility coding and charge capture as a certified coder
• Preferred: Formal auditing, consulting or vendor experience; experience using 3M-360; experience with hospital charging and revenue cycle initiatives

Reports To

Manager-Health Information Management Coding

Supervises

N/A

Ages of Patients

N/A

Blood Borne Pathogens

Minimal/ No Potential

Skills, Knowledge, Abilities

• 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 such as Coding Clinic, CPT Assistant, coding and charging for devices and implants, Local/National coverage determinations and payer contracts
• Expert knowledge of 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
• Proficient in using Microsoft Office applications with advanced working knowledge of Excel
• Working knowledge of Epic workflows pertinent to HIM, coding, and revenue cycle
• Written and verbal communication skills

Essential Responsibilities

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