Revenue Cycle Analyst/Coder

eisenhower; United States; Presencial; USD 68.684.000 - 104.359.000; Jornada completa

Descripción de la vacante

Eisenhower is seeking a Revenue Cycle Auditor to perform integrity audits within the Charge Descriptive Master and related charge capture and reconciliation processes. The role demands analyzing issues, identifying root causes, and collaborating with departments to maximize reimbursement.

The candidate should have a background in medical billing, coding or auditing, with strong analytical and communication skills, and the ability to work with cross-functional teams to ensure compliance and

Formación

• Required: High school diploma, GED or higher level degree if hired after March 1, 2025
• Required: CPC or CCS within one year if hired after Jan 1, 2021
• Two years of medical billing, charge capture, coding or patient account auditing experience

Responsabilidades

• Audit revenue-generating departments' CDM files and ensure compliant recording
• Provide guidance on charge capture, billing and coding processes
• Submit audit findings and recommendations to leadership
• Assess accuracy of charge capture tools and recommend changes
• Review facility bill rejection reports and correct charges as needed
• Identify deficiencies in controls and advise leadership
• Assist department charge custodians with bill rejection charges
• Maximize collections by aligning with payor contracts and terms
• Coordinate with Revenue Recognition, Charge Master, Payor Relations and PFS teams
• Participate in process improvement initiatives
• Perform other duties as assigned

Conocimientos

Analytical thinking

Problem solving

Interpersonal relations

Process integration

Financial analysis tools

Research skills

Communication skills

Charge capture knowledge

Educación

High school diploma or GED

Medical coding coursework or related bachelor's

Herramientas

PC applications

Database

Report generators

Descripción del empleo

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

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. 1. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
2. 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. 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. 4. Prepares and submits audit findings to leadership to review and compile recommendations.
5. 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. 6. Reviews facility bill rejection reports to correct, edit or apply appropriate modifiers to charges for compliant billing practices, as appropriate.
7. 7. Examines reports, and makes recommendations regarding deficiencies in controls, duplication of effort, fraud, or lack of compliance to leadership.
8. 8. Provides assistance to all hospital department charge custodians to assist in completing their department identified bill rejection charges.
9. 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. 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. 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. 12. Performs other duties as assigned.