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Claims Review Specialist
2 months ago
Location: 10920 Wilshire Blvd, Los Angeles, CA 90024
Duration: 24 week contract
SHIFT: M-F 8-5
Note: This will be 99% remote, only the orientation will be onsite and a few meetings when necessary.
REQUIRED EXP:
- 5+ yrs exp with hospital billing systems and third-party billing requirements, Bachelor's Degree, coding certification (CPC,CPCH, AHIMA etc)
- Knowledge of ICD10CM CPT, Medicare, Medi-Cal and Commercial Payers processing, Denials management Preferred
- Take on a significant role within a world-class health organization. Elevate the operational and financial effectiveness of a complex health system.
- Analyze complex financial data
- Identify trends in revenue cycle operations
- Summarize data and present reports to leadership
- Serve as liaison with departments to thoroughly define reporting and information requirements
- Evaluate revenue cycle workflows to identify areas for improvement
- Oversee charge integrity, reconciliation, and charge linkages from ancillary charging systems
- Train patient financial services units on revenue cycle systems, processes and procedures
- Maintain compliance with government regulations, reimbursement issues, etc.
- Analyze hospital billing claims within the EHR and claim scrubber system
- Resolve claim errors, edits, and other holds
- Works with clinical and ancillary operational departments on correct coding, billing, and charging principles
We're seeking a highly analytical, detail-driven professional with:
- Bachelor's degree in business, finance or related field
- CPC-H, CPC, or CCS coding certification
- Five or more years of experience with hospital billing systems and third-party billing requirements
- Experience in revenue integrity operations, clinical charge capture, charge master, or revenue cycle operations
- Proficiency with Microsoft Excel
- Knowledge of Tableau Reporting dashboards
- Understanding of Medicare/Medi-Cal claims processing guidelines
- Experience with EPIC EHR, Cirius Claim Scrubber, or other EHR system
- In-depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle
- Strong analytical and problem-solving abilities
- Excellent communication, interpersonal, and collaboration skills
- Proficiency in the use of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and revenue codes
