Physician Billing Compliance Analyst - Revenue Integrity

Cedars-Sinai Medical Center

Los Angeles, CA

Job posting number: #7106888 (Ref: HRC0931800A)

Posted: July 30, 2022

Application Deadline: Open Until Filled

Job Description

Are you ready to bring your clinical competencies to a world-class Medical Group known for the very highest clinical standards? Do you have a passion for the highest quality and patient satisfaction? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.

The Cedars-Sinai Medical Network is committed to helping primary care and specialist physicians provide excellent care to all their patients, who benefit from convenient access to primary and specialty care physicians and seamless coordination of care between them. As a part of Cedars-Sinai, our physicians and staff are partners in quality health care from a medical center that is consistently recognized as one of the finest hospitals in the country. For the 8th consecutive year, we have been named one of the top 20 Physician Groups in Southern California by Integrated Healthcare Associates (IHA).

The Revenue Integrity Analyst quantifies trends and identifies and measures opportunities to increase net revenue. Assists with source identification and root cause resolution of denials and payment variances, including underpayment analysis and management. This position is responsible for identifying potential charge, gather workflow improvements and calculating consistent charge structure methodologies according to industry standards and payer contracts. The RI Analyst will also interpret and run a variety of metrics and reports, presenting regularly with departments and external stakeholders about operational and technical improvement areas to optimize revenues and ensure integrity and compliance in our charging and billing practices.

primary duties and responsibilities:

  • Conducts routine charge capture and reconciliation quality control audits. Re-audits workflows and processes if compliance opportunities are identified.
  • Leads and monitors system-wide charge audits process using reporting data and tracking tools.
  • Monitors and reviews existing billing workflows, inputs and outputs. Independently works with the appropriate team(s) to adjust processes and systems to mitigate revenue leakages and optimize efficiencies.
  • Prepares departmental summaries that pinpoint root causes of charge/billing errors and conceptualize process changes for Revenue
  • Works independently to manage quarterly and annual fee schedule maintenance work and special projects.
  • Uses independent judgment to analyze changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable charging and billing guidelines.
  • Collaborates with revenue integrity & revenue cycle compliance leadership to develop education plans to assist clinical service line leaders in achieving optimal reimbursement; may also coordinate or deliver revenue integrity and PBS staff training.
  • Participate in new business initiatives by researching appropriate billing codes, reimbursement and payer policies.

Job Qualifications

Education:

  • High School diploma required
  • Bachelor's Degree in Business, Finance Healthcare, or a related field preferred

Experience:

  • Three (3) years of experience with Physician Business Services (PBS) or Patient Financial Services (PFS) Accounts Receivable management.
  • Two (2) years of coding and/or audit experience.
  • Previous experience working in Analyst role or with database management.
  • Working Title: Physician Billing Compliance Analyst - Revenue Integrity
  • Department: MNS PBS Compliance
  • Business Entity: Medical Network
  • City: Los Angeles
  • Job Category: Patient Financial Services
  • Job Specialty: Revenue Integrity
  • Position Type: Full-time
  • Shift Length: 8 hour shift
  • Shift Type: Day

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at [email protected] and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu) and COVID-19. For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines such as COVID-19 as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy.





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