Medical Claims Review Manager jobs in Downey, CA

Position: Medical Claims Review Specialist
Location: 10920 Wilshire Blvd, Los Angeles, CA 90024
Duration: 24 week contract
SHIFT: M-F 8-5

Note: 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.