Medical Claims Review Specialist - Los Angeles, United States - NavitsPartners

Description

Job Description Job Description Position:
Medical Claims Review SpecialistLocation: 10920 Wilshire Blvd, Los Angeles, CA 90024Duration: 24 week contract


SHIFT:
M-F 8-5Note: This position is 99% remote, with only the orientation and occasional meetings requiring onsite presence

Job Summary:

We are seeking a skilled Revenue Integrity Analyst / Claims Review Specialist to join our team on a 24-week contract basis.

In this role, you will play a pivotal role in optimizing the operational and financial effectiveness of our complex health system.

Utilizing your in-depth knowledge of the healthcare revenue cycle, you will analyze complex financial data, identify trends in revenue cycle operations, and provide insightful reports to leadership.

Your focus will be on ensuring charge integrity, reconciliation, and compliance with regulatory requirements while supporting clinical and ancillary operational departments in correct coding, billing, and charging principles.

Key Responsibilities:

Data Analysis:
Analyze complex financial data and identify trends in revenue cycle operations

Reporting:
Summarize data and present comprehensive reports to leadership

Liaison Role:
Serve as a liaison with various departments to define reporting and information requirements

Workflow Evaluation:
Evaluate revenue cycle workflows to identify and implement improvements

Charge Integrity Oversight:
Oversee charge integrity, reconciliation, and charge linkages from ancillary charging systems

Training and Support:
Train patient financial services units on revenue cycle systems, processes, and procedures

Compliance and Regulation:
Maintain compliance with government regulations and address reimbursement issues

Claims Analysis:
Analyze hospital billing claims within the EHR and claim scrubber system, resolving claim errors, edits, and other holds

Collaboration:
Work closely with clinical and ancillary operational departments on correct coding, billing, and charging principles

Required Qualifications:

Education:
Bachelor's degree in business, finance, or a related field

Certifications:
CPC-H, CPC, or CCS coding certification


Experience:
Five or more years of experience with hospital billing systems and third-party billing requirements

Technical Proficiency:
Proficiency with Microsoft Excel and Tableau Reporting dashboards
System

Experience:
Familiarity with EPIC EHR, Cirius Claim Scrubber, or other EHR systems

Coding Knowledge:
Proficiency in Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and revenue codes

Regulatory Knowledge:
Understanding of Medicare/Medi-Cal claims processing guidelines and knowledge of ICD-10-CM and CPT

Skills:
Strong analytical and problem-solving abilities, excellent communication, interpersonal, and collaboration skills.#J-18808-Ljbffr