Revenue Cycle Management Analyst - CoreTechs

Revenue Cycle Analyst
Santa Barbara, CA 93111 – Hybrid
 
What experience are you looking for?

• Clear understanding of billing rules for all payers
• Clear understanding of denial management, tracking trends
• Ability to manage claim follow-up and optimize workflows to avoid denials
• Clear understanding of timely filing guidelines
• Clear understanding of Implant billing
• Minium of 5 years Ambulatory Outpatient procedure billing

 
SUMMARY:

• Plays a critical role in staff's productivity to ensure high quality and accuracy of work, exceptional customer service, adherence to applicable federal and/or state laws and regulations, and company and department policies and procedures are followed. Proactively recognizes predicaments associated with complex issues. Provides feedback to leadership and makes recommendations for performance improvement goals and suggests areas for specific remedial training and also for process improvement activities. Collaborates with the operational leadership and/or other teams and may assist in the development and implementation of applicable and efficient processes and procedures.

 
These Principal Accountabilities, Requirements and Qualifications are not exhaustive but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development)
 
JOB ACCOUNTABILITIES:
Identifies error trends from data obtained through claims review, telephone calls, written correspondence, payments posting and/or reconciliation, and configuration and system rules or builds set up:

• Tracks trends to identify reoccurring quality findings
• Researches, analyzes, reports, and tracks issues proactively and comprehensively

Analyzes workflows and processes in order to discover and report any inefficiency:

• Ensures that employees’ activities meet business requirements and goals
• Prepares reports and analyzes findings for operational leadership decision support
• Recommends and assists in the development and delivery of appropriate training solutions through analyzing data according to Sutter Health standard and guidelines, department workflows and policies and procedures, and applicable federal and/or state laws and regulations

Works closely with operational leadership to manage the resolution of issues:

• Ensures accurate and timely data input
• Develops best practices for maintaining and reporting on issues
• Acts as a resource to medical group clinicians and staff for coding, compliance and billing questions by staying current on Federal and State rules and regulations

Lean:

• Utilize LEAN methodology for constant efficiency improvements

 
QUALIFICATIONS:
Education:

• Equivalent experience will be accepted in lieu of the required degree or diploma
• Bachelor's: Business, Healthcare Administration or related field or equivalent education/experience

Typical Experience:

• 2 years of recent relevant experience

Skills and Knowledge:

• General knowledge of Current Procedural Terminology (CPT), International Classification of Diseases-9 (ICD-9) and Healthcare Common Procedure Coding System (HCPCS) as well as Local, State and Federal coding regulations and guidelines
• Knowledge of coding and billing practices in a multi-specialty group clinic.Government billing regulations, including; Medicare, Medicare Managed Care and Medi-Cal/Medicaid
• Written and verbal communication skills
• Skilled in problem analysis and problem resolution
• Ability to develop effective working relationships/ networks within and outside the organization

 
We are an equal opportunity employer, and we are an organization that values diversity. We welcome applications from all qualified candidates, including minorities and person with disabilities.
 
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