Revenue Compliance Analyst - Remote

Valleywise Health System; Arizona; Remote; USD 80,000 - 118,000; Full time

Job summary

Valleywise Health is seeking a Revenue Compliance Analyst to research Federal and State regulations related to billing and CDM, and to perform independent chart and charge reviews for accuracy. You will analyze audit results and coordinate with the Business Office, compliance, and clinical teams to drive corrective actions.

The role requires at least two years of healthcare coding experience, working knowledge of CMS guidelines, and strong Excel skills.

Qualifications

• Requires a bachelor’s degree in business or related field, or equivalent experience.
• Minimum 2 years of healthcare coding experience with strong knowledge of billing and CDM.
• Experience with Excel and the Microsoft Office suite is required.

Responsibilities

• Research Federal and State regulations related to billing and CDM.
• Perform independent reviews of charts and charges for completeness and accuracy.
• Analyze audit results and recommend corrective actions with cross-functional teams.
• Maintain CDM to ensure code compliance and support rate changes.

Skills

Coding experience

Excel skills

Medical terminology

Communication skills

Analytical skills

multitasking

Education

Bachelor's degree in business or related field

Tools

Epic system

Job description

Under the direction of the Manager and Director Revenue Integrity, this Revenue Compliance Analyst position researches Federal and State regulations as they pertain to billing/revenue and CDM. Has working knowledge of chart/bill audits and clinical documentation and coding requirements. Performs independent reviews of patient charts and corresponding charges to ensure completeness and appropriateness of revenue cycle functions and charges. Analyzes the audit results, makes recommendations for corrective action when problems are discovered, and works with the Business Office, compliance, and clinical areas to facilitate all action plans and process changes. Resolves problem accounts in accordance with Valleywise Health policies and procedures. Assists in maintaining the CDM to assure code compliance. Helps develop/implement annual rate changes. Monitors and distributes all regulatory changes that pertain to charging and charge capture.

Valleywise Health

is committed to providing high-quality, comprehensive benefits designed to help our employees and their families stay physically and financially fit. Known for the diversity of not only the community of patients we serve but also our workforce and the benefits we offer, such as:

• Medical, Dental, and Vision Plans
• Flexible Spending Accounts
• 100% Retirement Match in the Arizona State Retirement System (ASRS)
• Paid Time Off and Paid Holidays
• Sick and Extended Illness Bank
• Tuition Reimbursement Programs
• And much more

Annual Salary Range: $79,913.60 - $117,873.60

This is a REMOTE opportunity.

Qualifications

Education:

• Requires a bachelor's degree in business or related field, or equivalent experience in related field.

Experience:

• Must have a minimum of two (2) years of progressively responsible varied healthcare coding experience that demonstrates a strong understanding of the required knowledge, skills and abilities.
• Prefer ten (10) years of progressive experience in the healthcare field, coding experience.
• Demonstrates an understanding of the standard tools, workflow processes, and/or procedures and concepts used in the deployment and development of application software necessary to run the healthcare systems business, clinical or financial systems.

Specialized Training:

• Epic certification in HB Charge Description Master and Cost Center assignment within six months of hire.

Certification/Licensure:

• Prefer certification(s) related to business, clinical, or financial application(s)/system(s). In addition, prefer professional clinical licensure (eg. RN, Radiology, Laboratory, Pharmacy, etc) if supporting clinical application systems.

Knowledge, Skills, and Abilities:

• Requires the ability to read, write and speak effectively in English.
• Coding experience required.
• Experience with Excel and other Microsoft Suite programs required.
• Experience with the Epic hospital billing and CDM systems desired.
• Working knowledge of chart/bill audits or ability to abstract medical information.
• Working knowledge of revenue cycle process as it relates to patient billing.
• Strong working knowledge of medical terminology, patient care services, and medical record chart documentation (IP and OP) is required.
• Thorough working knowledge of CMS compliance guidelines for hospital coding, billing and documentation; experience in Utilization Review/Case Management and compliance auditing preferred.
• Strong analytical, writing and communication skills.
• Must be able to demonstrate the ability to handle multiple priorities and deadlines while using independent judgment.
• Must possess good interpersonal and communication skills both verbally and in writing including ability to inform, advise, and instruct.
• Requires the ability to develop initiatives in innovative manner for effective resolution.