Revenue Cycle Analyst/Coder

Eisenhower Health; Rancho Mirage (CA); On-site; USD 50,000 - 76,000; Full time

Job summary

Eisenhower Health in Rancho Mirage, CA seeks a Revenue Cycle Auditor to perform integrity audits within the Charge Descriptive Master and related processes. The role requires CPC/CCS certification within a year and 2 years of billing or auditing experience.

Responsibilities include ensuring proper charging, guiding staff on charge capture, and reviewing reports to improve compliance and reimbursement. A strong analytical, collaborative approach is essential.

Qualifications

• Education: Required: High school diploma, GED or higher level degree; Preferred: medical coding coursework or bachelor’s degree in related field
• Licensure/Certification: Required: CPC or CCS within one year if hired after Jan 1, 2021
• Experience: Required: Two years of medical billing, charge capture, coding or patient account auditing experience; Preferred: revenue cycle experience, hospital/clinical experience

Responsibilities

• Demonstrates compliance with Code of Conduct and compliance policies and reports suspected violations.
• Performs audits of all revenue generating departments’ CDM files and conducts departmental interviews to ensure proper recording and compliance with state and federal guidelines.
• Provides guidance and education to staff on correct charge capture, current charging structure, and billing and coding processes to eliminate duplicate, inactive or non-compliant charges.
• Prepares and submits audit findings to leadership with recommendations.
• Assesses the accuracy of charge capture tools and recommends changes to meet standards.
• Reviews facility bill rejection reports to correct, edit or apply modifiers for compliant billing.
• Examines reports and makes recommendations regarding deficiencies in controls or compliance.
• Assists department charge custodians in completing their identified bill rejection charges.
• Maximizes collection by understanding payor contracts and makes recommendations to improve payments.
• Acts as liaison between Revenue Recognition, Charge Master, Payor Relations and PFS for charge structures and rates.
• Identifies process improvements and participates in hospital process improvement teams.
• Performs other duties as assigned.

Skills

Analytical thinking

Root cause analysis

Interpersonal relations

Financial analysis

Charge capture workflows

Research skills

Written and verbal communication

Education

High school diploma or equivalent

Medical coding coursework or related degree preferred

CPC/CCS certification within 1 year

Tools

PC applications

Database knowledge

Reporting tools

Job description

Default Work Shift:

Day (United States of America)

Hours:

40

Salary range:

$23.97 - $36.42

Schedule:

Full Time

Shift Hours:

8 Hour employee

Department:

Patient Financial Services

Job Objective:

Responsible for performing revenue cycle integrity audits within the Charge Descriptive Master and other revenue cycle charge capture and reconciliation processes.

Job Description:

Education: Required: High school diploma, GED or higher level degree if hired after March 1, 2025 Preferred: Medical coding coursework or bachelor’s degree in related field Licensure/Certification: Required: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) within one (1) year if hired into position after January 1, 2021 Experience: Required: Two (2) years of medical billing, charge capture, coding or patient account auditing experience Preferred: Revenue cycle experience, hospital/clinical experience

Reports To: Manager or Director Supervises: N/A Ages of Patients: N/A Blood Borne Pathogens: Minimal/ No Potential

Skills, Knowledge, Abilities:

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

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. 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.
3. 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.
4. Prepares and submits audit findings to leadership to review and compile recommendations.
5. 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.
6. Reviews facility bill rejection reports to correct, edit or apply appropriate modifiers to charges for compliant billing practices, as appropriate.
7. Examines reports, and makes recommendations regarding deficiencies in controls, duplication of effort, fraud, or lack of compliance to leadership.
8. Provides assistance to all hospital department charge custodians to assist in completing their department identified bill rejection charges.
9. 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.
10. 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.
11. 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.
12. Performs other duties as assigned.