Senior Revenue Integrity Analyst

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🕒 May 28

🏄 California – Remote

🏄 California – Remote

⏰ Full Time

🟠 Senior

🧐 Analyst

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Community Memorial Healthcare

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1902

⚕️ Healthcare Insurance

🤝 Non-profit

🧘 Wellness

Healthcare Insurance • Non-profit • Wellness

Community Memorial Healthcare is a trusted leader in local healthcare, known for providing exceptional care with a renewed passion for partnering with patients. With a wide range of services, including emergency care, surgery, rehabilitation, and specialty care, it operates in various health centers and hospitals in Ventura and Ojai. The organization is committed to community service, offering programs like residency training and community health assessments. Supported by community donations, Community Memorial Healthcare invests in advanced medical technology and education to enhance patient care and community partnerships.

📋 Description

• Reviews, analyzes, and verifies accuracy of CDM, fee schedules, and associated master files. Performs, documents, and communicates annual/interim price adjustments. • Assists the Director of Revenue Integrity with driving charge capture and revenue reconciliation at the department level to ensure all charges are being captured. • Promotes and implements common statistics and productivity units accumulated via charge master services, common billing codes for similar services, common revenue billing requirements for managed care contracts, and common strategic pricing and mark-up formulas for selected facilities/programs. • Ensures CDM updates occur on a regular basis, synchronize financial systems with CDM maintenance vendor tool monthly, scripts work smoothly, new users are trained, and regular communication with CDM maintenance vendor support with issues and suggestions to continue to enhance the product. • Provides assistance, investigation, research, interpretations, education, reference material, documentation, and policies for CDM-related and Compliance issues/questions to internal and external partners. • Interfaces with and provides education and training to clinical staff to improve charging process. • Performs periodic reviews of each CDM to inactivate or zero-out obsolete, inactive, and non-billable charge codes.

🎯 Requirements

• Minimum: Bachelor’s degree or equivalent work experience or two years of work experience per one year of required education. • Minimum: Coding certification (CCS, CCS-P, CPC, COC) • Preferred: Registered Nurse. RHIA, Epic Certification in Resolute Charge Capture and/or Clarity Report Data. American Association of Healthcare Administrative Management (AAHAM) - Certified Revenue Integrity Professional (CRIP). • Minimum: Knowledge of MS Excel. Knowledge of billing requirements related to charges and associated claim forms. Knowledge of cost accounting concepts, principles, and computer applications. • Preferred: Experience with electronic medical records and clinical application software. • Able to take initiative to raise issues; able to educate and support co-workers in the successful completion of payor and financial tasks. • The employee communicates effectively. Able to clearly communicate verbally, electronically, and in writing. • Able to identify procedural issues in need of improvement and participate in the change processes.

🏖️ Benefits

• Pay for non-physician positions is determined based on related years of experience and internal equity. Eligible employees may also receive additional forms of compensation, including shift differentials, on-call pay, incentive pay, and bonus opportunities, where applicable. Manager and above positions may participate in Cottage Health’s annual management incentive program. Physician compensation is determined based upon specialty and may include bonus potential. For more information on our comprehensive Total Rewards offerings, please visit https://cottagehealth.org/careers/total-rewards.