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Revenue Integrity Claims Specialist Job in Los Angeles, California

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Job Title: Revenue Integrity Claims Specialist

Employer:UCLA Health
Type:FULL TIME
Required Certifications:CCS,or CPC/CPC-H certification,CCS-P
Location: Los Angeles 90095, CA, US
Date Posted:9/13/2021
Responsibilities

As the Revenue Integrity Claims Specialist, you will be responsible for:

·      Analyzes hospital billing claims within the EHR and claim scrubber system and resolves claim errors, edits, and other holds through medical documentation review and reference to compliance guidelines from Medicare and Medi-Cal.

·      Evaluating and performing claims auditing for identifying and analyzing root causes for line item denials for all Government and Commercial payor sources.

·      Working with clinical and ancillary departments to educate managers on correct coding, billing, and charging principles.

·      Assists operational managers with improving revenue capture while reversing negative outcomes, e.g. denials and/or claims rejections

·      Analyzing large volumes of hospital claims data and reports generated from CareConnect, Clarity, OHIA, Medicare T screen, and Decision Support to determine potential and on-going revenue recovery initiatives and revenue recovery goals

·      Leading, supporting, and coordinating charge capture activities and operations

·      Assisting in charge automation initiatives, lead revenue optimization initiatives and collaborate with Revenue Cycle business partners on system enhancements and upgrades.

·      Supporting charge reconciliation activities and associated reporting

·      Supporting and coordinating all hospital-based clinic departments by providing charge audit activities, education, training, charge master management support and ongoing monitoring of charge capture related metrics.

Note: This posted position is 1 of 2 positions available for hire. All applicants will apply through this requisition and if selected will be hired into one of the available positions. 

 

Qualifications

We are seeking a self-directed, detail-oriented professional with:

·      A CCS, CCS-P, or CPC/CPC-H certification

·      Experience in Revenue Integrity Operations, Clinical Charge Capture, Charge Master or Revenue Cycle Operations

·      Knowledge of the practices and procedures of the healthcare Revenue Cycle, specifically Revenue Integrity Operations, including charge capture, billing, coding, charge master, reimbursement, regulatory and compliance guidelines

·      Knowledgeable in use and application of Current Procedural Terminology (CPT), Health Common Procedure Coding System (HCPCS), and Revenue Codes

·      A minimum of 3-5 years of working with hospital billing systems and knowledge of third party billing requirements

·      Knowledge of automated patient account function and be familiar with Electronic Health Record (EHR) interfaces, extrapolation of data and charge processing

·      Experience in managing and/or developing charge capture processes, policies, and procedures

·      Skill to read and correctly interpret governmental and commercial payer regulations and develop and implement recommendations consistent with interpretation

 

UCLA is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.

Applying


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