revenue integrity analyst

OrthoVirginia

<div><p>At OrthoVirginia, you&rsquo;re part of a team dedicated to delivering expert orthopedic and therapy care across the state. As Virginia&rsquo;s largest provider of musculoskeletal care, we offer full-time and part-time opportunities in a collaborative, team-oriented environment.</p><p></p><p>
With more than 159 physicians in over 35 locations&mdash;including Lynchburg, Northern Virginia, Richmond, Southwest Virginia, and Hampton Roads&mdash;OrthoVirginia is a leader in orthopedic surgery, non-surgical care, and physical, hand, and occupational therapy. Our nationally recognized specialists treat a full range of musculoskeletal injuries and conditions, helping patients of all ages move, heal, and thrive.</p><p></p><p>
Join us and become part of a trusted network committed to excellence in orthopedic care.</p><p></p><p><b>
Reporting and Analysis:</b></p><ul><li>
Analyze key performance indicators (KPI&rsquo;s) revenue cycle metrics identifying trends, creating and maintaining reports and dashboards for leadership and performing root cause analysis on revenue cycle issues.</li><li>
Ensure the prevention of payment denials and claim resolution by investigating and correcting claim edits, denials, holds and system edits and billing rules set up.</li><li>
Charge Master Management (CDM): Overseeing charge master accuracy, testing updates and integrating new services. Updates CPT, HCPCS and revenue codes to ensure accurate pricing and billing transparency.</li><li>
Determine appropriate methods to analyze operations, relevant information, and data. Create new queries and analysis tools, develop databases as needed and acquire desired data.</li><li>
Interprets results, identifies trends, and provides director with business insights and performance metrics using data analysis methods and modeling.</li><li>
Education, Compliance &amp; Auditing: Provide training and resources to clinical and billing staff on proper charging and documentation practices.</li><li>
Performs analysis on an ad hoc basis as required to support the operational needs of the Patient Accounts Department.</li><li>
Able to communicate effectively (written and verbal) the findings of analyses and audits to support operation and financial decisions.</li><li>
Acts a local support and super user in systems including EMR, clearinghouse and variance denials tools, working with all levels of associates to identify issues and root causes and make recommendations for process improvements.</li><li>
Provide project management support for leadership. Leads implementation plans to ensure stability of workflows and solutions.</li><li>
Lead the implementation and management of automation reports, dashboards, and other SQL-based analytics tools used for revenue cycle and other critical business functions.</li><li>
Create and manage documentation (such as SOPs and data dictionaries) for various data solutions, reports, and dashboards.</li></ul><p></p><p><b>
Teamwork:</b></p><ul><li>
Works cooperatively with coworkers, providers, and management.</li><li>
Shares knowledge and insights with co-workers in a constructive manner.</li><li>
Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.</li><li>
Addresses conflicts with person directly before involving manager or uninvolved peers.Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department.</li></ul><p></p><p><b>
Policies and Procedures:</b></p><ul><li>
Knows and complies with policies and procedures as enumerated in the company employee handbook and policies and procedures documents.</li><li>
Provides assistance and support to leadership in implementing policies and procedures as necessary.</li><li>
Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.</li></ul><p><b>
Education, Experience, and Certification/Licensure Required:</b></p><p>
A bachelor&rsquo;s or associate degree in Healthcare Administration, Finance, Health Information Systems, Statistics, or a related field is required.</p><p>
A minimum of <b>five</b> years of professional experience, preferably in a healthcare setting, is required. <b>Experience should include working with large datasets, developing complex queries and analyses, managing multiple projects, and preparing reports and presentations within a multidisciplinary team environment for leadership.</b></p><p>
This role requires a strong understanding of medical terminology, human anatomy, ICD10/CPT coding, and medical insurance reimbursement models.</p><p>
Candidates must demonstrate proficiency with Microsoft Office applications, including Excel, Word, Teams, and PowerPoint. <b>SQL and Epic EMR experience are required.</b></p><p>
Excellent communication, analytical thinking, facilitation, problem solving, and project leadership skills are essential.</p><p>
This organization participates in e-Verify. Esta organizaci&oacute;n participa en e-Verify.</p></div>

Revenue Integrity Analyst

Beth Israel Lahey Health

Woburn, MA &bull; Beth Israel Deaconess Medical Center &bull; Regular &bull; Day
<br><div><p><b>When you join the growing BILH team, you're not just taking a job, you&rsquo;re making a difference in people&rsquo;s lives.</b></p>
<p></p>
<p>Under the direction of the Director, Revenue Integrity and Coding at Harvard Medical Faculty Physicians (HMFP) at the Beth Israel Deaconess Medical Center (BIDMC), the Revenue Integrity Senior Analyst contributes to Revenue Integrity and Coding oversight at the enterprise, which aims to maximize synergies across HMFP departments, initiate and lead revenue integrity and coding process improvement, identify and address risks, monitor key revenue integrity and coding operational and financial metrics, provide subject-matter expertise, and ensure adherence to established standards and policies.</p>
<p></p>
<p><b>Job Description:</b></p>
<div><b>
Primary Responsibilities</b><br>
<ul><li>Monitor departments&rsquo; adherence to professional charge reconciliation, work-queue, and professional coding quality expectations and support departments with education, process improvement, and follow-up.</li><li>Conduct periodic departmental reviews of professional charge reconciliation processes to ensure adherence to policies and confirm all professional charges are captured and reported accurately</li><li>Review and document changes within the charge description master (CDM) and fee schedule(s) and ensure these changes are implemented within appropriate systems. Route for approval in accordance with HMFP&rsquo;s established policies and procedures.</li><li>Lead annual, quarterly, and regular CDM and fee schedule maintenance activities.</li><li>Review changes in CPT, HCPCS, and wRVUs for accuracy, compliance with applicable coding and billing guidelines, and optimization of reimbursement.</li><li>Support departments with analyzing services for coverage and reimbursement.</li><li>Work with HMFP departments to identify revenue management opportunities, staying current with government and commercial payers&rsquo; billing and coding requirements.</li><li>Develop, deliver, and revise revenue integrity and coding education and training programs in coordination with the Director and HMFP Compliance Department.</li><li>Monitor, investigate, and report revenue integrity and coding quality concerns to appropriate stakeholders and provide any necessary follow-up.</li><li>Monitor national, state, and local information to keep current with applicable regulatory and legislative changes and tailor the revenue integrity program accordingly.</li><li>Monitor coder quality audit results and coder productivity. Support departments by establishing audit processes, providing education and training, implementing process improvements, and conducting follow-up.</li><li>Lead assigned revenue integrity and coding projects, committees, and meetings.</li><li>Develop and execute tools and processes to identify potential areas of delayed or lost revenue. Collaborate with departments on process improvement and necessary follow-up.</li><li>Build strong relationships and facilitate effective communication between key stakeholders. Collaborate with others to develop and implement action plans to resolve revenue integrity and coding issues.</li><li>Prepare oral and written reports and presentations summarizing reviews, findings, recommendations for improvement, and actions taken for the Director and other stakeholders.</li></ul></div><br>
<div><b>
Required Qualifications</b><br>
<ul><li>Bachelor&rsquo;s degree required.</li><li>Certification: Certified Professional Coder (CPC) required.</li><li>5 or more years of physician/professional revenue operations experience with a focus in one or more of the following areas: coding, revenue integrity, charge reconciliation, charge compliance, charge auditing, and CDM management.</li><li>EPIC PB experience preferred.</li><li>Extensive knowledge of:</li></ul>
o revenue cycle processes and physician billing<br>
o code sets to include Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS), and International Classification of Diseases (ICD-10)<br>
o reimbursement theories to include RBRVUS, MPFS, and managed care<br>
o NCCI edits and Medicare LCD/NCDs<br>
o health care documentation, coding, and billing requirements, as well as federal and state health care regulatory requirements<br>
o health care compliance<br>
o medical terminology, anatomy, and physiology, along with clinical department activities.<br>
<ul><li>Abilities:</li></ul>
o Manage large complex project assignments, investigate, analyze, and resolve issues at a high level.<br>
o Excellent communication, presentation, organizational, analytical, and problem-solving skills. Must communicate effectively with physicians, leadership, and other billing personnel.<br>
o Must approach problem-solving challenges independently, have strong attention to detail, and enjoy working in a fast-paced, collaborative team-based environment.<br>
o Advanced skills with Microsoft Office, including Outlook, Word, Excel, PowerPoint, Power BI, and other web-based applications. Ability to produce complex documents.<br>
o Strong analytical ability. Skills to collect, organize, and analyze data, produce actionable reports, and recommend improvements and solutions.</div><br>
<div><b>
Social/Environmental Requirements</b><br>
<ul><li>Work requires periods of close attention to work without interruption. A concentrated effort of up to 4 hours without a break may be required.</li><li>Work requires constant response to changing circumstances and using new information to adjust approach and to quickly respond to new needs.</li><li>No substantial exposure to adverse environmental conditions.</li><li>Health Care Status: NHCW: No patient contact. Health Care Worker Status may vary by department</li></ul></div><br>
<div><b>
Sensory Requirements</b><br>
<ul><li>Close work (paperwork, visual examination), Color vision/perception, Visual monotony, Visual clarity&gt; 20 feet, Visual clarity feet, Conversation, Telephone.</li></ul></div>
<p></p>
<div><b>Physical Requirements</b><br>
<ul><li>Sedentary work: Exerting up to ten pounds of force occasionally in carrying, lifting, pushing, or pulling objects. Sitting most of the time, with walking and standing required only occasionally.</li><li>This job requires constant sitting and keyboard use. There may be occasional walking and standing.</li></ul></div><br>
<p></p>
<p></p>
<p><b>Pay Range:
</b></p><p>$55,370.00 USD &ndash; $74,110.00 USD</p>
<p>
The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.</p>
<p></p>
<h2 class="jobSectionHeader"><b>As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.</b></h2>
<p></p>
<h2 class="jobSectionHeader"><b>More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.</b></h2>
<p></p>
<h2 class="jobSectionHeader"><b>Equal Opportunity Employer/Veterans/Disabled</b></h2></div><p></p>
<br><div><h3 class="jobSectionHeader"><b>Job details</b></h3>
<ul><li><div><b>Employment:</b> Regular</div></li>
<li><div><b>Hours/Week:</b> 40</div></li>
<li><div><b>Shift:</b> Day</div></li>
<li><div><b>Category:</b> Revenue Integrity</div></li>
<li><div><b>Pay Range:</b> $55,370.00 USD - $74,110.00 USD</div></li>
<li><div><b>FLSA:</b> Exempt</div></li>
<li><div><b>Req ID:</b> JR90083</div></li></ul></div>

Revenue Integrity Senior Analyst

Norton Healthcare

<div>Responsibilities:
<div>
The Sr. Revenue Integrity Pharmacy Analyst is responsible for expert review of pharmacy related charge audits, denials, quarterly HCPCS updates, and value analysis. They will review and analyze pharmacy claims, collaborating with pharmacy IS, Billing and Managed Care to ensure compliance with billing regulations while maximizing reimbursement. Additionally they provide support and education to Pharmacy and Revenue Cycle teams on coding and documentation requirements. Strong attention to detail with extensive knowledge in Pharmacy billing, coding, payor policies, federal regulations and reimbursement methodologies are essential for this role.</div><div></div><div><b><br>
**This position offers a fully remote work opportunity. Employees in this role must reside in one of the following states to be considered for fully remote positions: Kentucky, Indiana, Missouri, Ohio, Tennessee, Alabama, Virginia, Mississippi, North Carolina, South Carolina**</b></div>
Qualifications:
<div><b>
Required:</b></div><ul><li>
Three years of experience in healthcare revenue cycle, clinic operations or pharmacy technician</li><li>
One of: CCA or CCS or CIC-ICD or COC or CPC or RHIA or RHIT</li></ul><div><b>
Desired:</b></div><ul><li>
One year of pharmacy experience</li></ul></div>

Senior Revenue Integrity Pharmacy Analyst, Revenue Integrity/Coding Administration, Days, Fully Remote

Keck Medicine of USC

<div><p>As the center of clinical charge capture, the Revenue Integrity (RI) Specialist provides leadership to the daily CDM maintenance workflow between the various entities of Keck Medical Center of USC and monitors the alignment of the various entities to the standard policy for maintaining the CDM. The RI Specialist is responsible for the timely and accurate synchronization of data between the CDM residing in the billing system and CDM management tools . The Senior RI Specialist shall ensure that the Chargemaster (CDM) is consistent with all coding and billing regulations and accurately represents services provided. This includes ensuring all annual updates required by Medicare and other third-party payers are up to date. The Senior RI Specialist delivers direction to the documentation of all policies and procedures regarding CDM Maintenance and charge process; and conducts meetings to evaluate department charge processes to improve charge capture and coding compliance. The Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement. The Senior RI Specialist works closely with revenue auditors and provides leadership by providing direction to the revenue auditor team to all entities of Keck Medical Center of USC in the research and resolution of requests in a timely manner; and aid in the training and skill development of auditors to maximize available tools for Chargemaster and billing compliance.
</p><p><b>Essential Duties:
</b></p><ul><li>Performs maintenance to the Keck Medical Center of USC Charge Description Master (Keck &amp; Norris) ensuring all annual updates required by Medicare and other third-party payers are up to date. Assists the Revenue Cycle in annual coding review and processing of updates.
</li><li>Reviews and process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections and on-going identified changes for current systems to maintain compliance with both state and federal regulatory agencies.
</li><li>Leads and conducts meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address issues involving compliance with government regulations, third party payor needs and industry standards.
</li><li>Acts a subject matter expert for projects that impact revenue integrity and CDM. Subject matter expert to meet and/or communicate with various stakeholders for projects that impacts revenue integrity and the CDM.
</li><li>Takes the lead and exercises significant judgement and discretion on projects that have a broad, organizational impact.
</li><li>Coordinates and provides leadership to Revenue/Chart Audit team associated with research and resolution of account issues related to the CDM, charge capture, and other issues considered to be revenue integrity.
</li><li>Synchronizes CDM data between CDM and CDM Workflow &amp; Management Tool for Keck Medical Center of USC entities on a monthly basis.
</li><li>Imports/extracts data from various sources and in various formats as needed to review, monitor, track, and maintain the integrity of the CDM and associate charge flow process.
</li><li>Provides CDM data as necessary based on identified issues in form of ad-hoc reports.
</li><li>Provides guidance and education to ensure that CDM&rsquo;s and Charge Capture as needed of exist and newly acquired entities (i.e. Verdugo Hills) follow the standards and policies of Keck Medical Center of USC.
</li><li>Performs charge reconciliation activities, industry best practice research, and identifies and deploys charge capture improvement initiatives.
</li><li>Interprets and explains on details of charge services provided as needed.
</li><li>Participates collaboratively with Revenue Cycle and Ancillary team in the development, execution, and follow-up of education programs for USC Administration, Managers and Staff on all issues related to the charge master, charge capture, and new applications related processes.
</li><li>Participates in the development of policies and procedures, monitoring tools for late charges and establishment of procedures for timely and accurate charge capture mechanisms.
</li><li>Enhances professional growth and development
</li><li>Actively participates in team development, contributes to dashboards, and in accomplishing team, departmental, and organizational goals and objectives.
</li><li>Performs other duties as assigned.
</li></ul><p></p><p><b>Required Qualifications:
</b></p><ul><li>Req Associate&rsquo;s Degree Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or similar/related field.
</li><li>Req Specialized/technical training Certification from an accredited program of Certified Coder (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year from date of hire.
</li></ul><ul><li>Req 5 years Experience in healthcare field required. Related experience may include a combination of clinical service delivery (nursing or allied health), coding, provider billing, medical records, charge audit environment, CDM maintenance, Medicare/Medicaid reimbursement, managed care contractual arrangements, and patient accounting.
</li><li>Req Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology.
</li></ul><ul><li>Req Knowledge of other government and third-party payer reimbursement methodology required.
</li><li>Req Must be able to implement a systematic, self-motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plan
</li><li>Req Proficient skills and knowledge in MS Office/ Windows
</li></ul><p></p><p><b>Preferred Qualifications:
</b></p><ul><li>Pref Bachelor&rsquo;s Degree Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or similar/related field.
</li><li>Pref Experience and knowledge of Hospital charging practices.
</li><li>Pref Healthcare operations experience, particularly in an acute care hospital setting.
</li><li>Pref Current knowledge of the Revenue cycle, specifically the flow of charges in and across hospital billing systems.
</li><li>Pref Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets).
</li><li>Pref Working knowledge of CPT, HCPCs and ICD9 coding principles.
</li><li>Pref Skills and knowledge on the following software: Cerner and Craneware
</li><li>Pref Registered Nurse - RN (CA Board of Registered Nursing)
</li><li>Pref Pharmacy Technician (CA DCA)
</li></ul><p></p><p><b>Required Licenses/Certifications:
</b></p><ul><li>Req Specialty Certification Certified Coder (CCS or CPC), Certified Outpatient Coder-COC (AAPC) or Certified Auditor (CPMA) obtained within one (1) year of date of hire.
</li><li>Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
</li></ul><p></p>The annual base salary range for this position is $95,680.00 - $158,230.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate&rsquo;s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.<br>
<p></p><p><b>USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to the </b><b>Background Screening Policy Appendix D </b><b>for specific employment screen implications for the position for which you are applying.
</b></p><p></p><p><b>We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at </b><b>uschr@usc.edu </b><b>. Inquiries will be treated as confidential to the extent permitted by law.
</b></p><p></p><ul><li>Notice of Non-discrimination
</li><li>Employment Equity
</li><li><i>Read USC&rsquo;s Clery Act Annual Security Report
</i></li><li><i>USC is a smoke-free environment
</i></li>Digital Accessibility<br>
<li>
</li></ul><p></p><p>If you are a current USC employee, please apply to this USC job posting in Workday by copying and pasting this link into your browser:
</p>https://wd5.myworkday.com/usc/d/inst/1$9925/9925$144704.htmld</div>

Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union)

Parallon

<p></p><div><p><b>Introduction</b></p>
<p><b>This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).</b></p>
<p>Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a(an) Billing Integrity Analyst Credentialed today with Parallon.</p>
<p><b>Benefits</b></p>
<p>Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:</p>
<ul><li>Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.</li><li>
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.</li><li>
Free counseling services and resources for emotional, physical and financial wellbeing</li><li>
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)</li><li>
Employee Stock Purchase Plan with 10% off HCA Healthcare stock</li><li>
Family support through fertility and family building benefits with Progyny and adoption assistance.</li><li>
Referral services for child, elder and pet care, home and auto repair, event planning and more</li><li>
Consumer discounts through Abenity and Consumer Discounts</li><li>
Retirement readiness, rollover assistance services and preferred banking partnerships</li><li>
Education assistance (tuition, student loan, certification support, dependent scholarships)</li><li>
Colleague recognition program</li><li>
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)</li><li>
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.</li></ul>
<p>Learn more about Employee Benefits</p>
<p><b><i>Note: Eligibility for benefits may vary by location.</i></b></p>
<p>Come join our team as a Billing Integrity Analyst Credentialed. We care for our community! Just last year, HCA Healthcare and our colleagues donated $13.8 million dollars to charitable organizations. Apply Today!</p>
<p><b>Job Summary and Qualifications</b></p>
<p>The Billing Integrity Analyst (credentialed) is responsible for determining the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPTs, by reviewing the medical record, facility protocol, and other applicable documentation. This review includes the verification of billing data for accuracy and completeness, following regulatory requirements, in order to resolve edits or exceptions detected during system processing of the claim in Patient Accounting, Relay Health or the payer. Applies modifiers when appropriate based on this review, and/or makes necessary adjustments to patient account charges and/or balances. Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and HCA standards. Combines or splits accounts as appropriate. Serves as a liaison between facilities Administration, Shared Services Center, and ancillary department directors regarding charging issues, clinical documentation issues and revenue opportunities. Provides charge review results and develops and coordinates educational in-services for facility staff related to charging/billing issues. Coordinates retrospective, concurrent, patient requested, and external billing audits. Reviews denial trends for documentation and charging opportunities. Serves as a primary contact for charge related SSC and facility inquiries and issues.</p>
<p><b>In this role you will:</b></p>
<ul><li>Analyze and resolve specific billing edits that require HCPCS/CPT coding based on the chargemaster expertise and that are delaying claims from processing in the Patient Accounting and/or Relay Health systems. This includes the verification (and/or correction) of billing data for accuracy and completeness, by following regulatory requirements, and reviewing the medical record, facility protocol, and other applicable documentation. This also includes the application of modifiers and condition codes, as appropriate.</li><li>
Identify charging, chargemaster coding, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues that are identified while working on edits.</li><li>
Serve as charge master liaison to facilitate clinical department education on appropriate charging of CPT codes, Revenue Codes, and communicating with Ancillary Departments to resolve issues. Coordinates updates (activate, inactivate, modification) with Ancillary Departments as necessary</li><li>
Review Regulatory and Compliance Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD). Assess impact to Billing Integrity procedures and implement changes as needed.</li><li>
Maintain billing education, attend webcasts and conference calls as required.</li></ul>
<p><b>Qualifications:</b></p>
<ul><li>Associate Degree or above; or healthcare license/certification required.</li><li>
Minimum 1 year directly related Healthcare experience or coding experience required.</li><li>
Knowledge of CPT/HCPCS codes or experience in charging or performing charging validation reviews preferred.</li><li>
Healthcare certification/licensure such as RHIT, CCS, CCP,CPC or other recognized AHIMA certified coding credential, LPN, LVN, RT, PT, etc., can be accepted lieu of degree with work experience.</li></ul>
<p><b>Parallon</b> provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.</p>
<p>HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.</p><br>
<p></p><br>
<br>
<p>&quot;The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual.&quot;- Dr. Thomas Frist, Sr.<br>
HCA Healthcare Co-Founder</p>
<p>If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Billing Integrity Analyst Credentialed opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. <b>Unlock the possibilities and apply today!</b></p>
<p><i>We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</i></p></div><p></p>

Billing Integrity Analyst Credentialed

<p></p><div><h5 class="jobSectionHeader"><b>Introduction</b></h5><p>
This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).</p><p>
Do you want to join an organization that invests in you as a Billing Integrity Analyst RN? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.</p><h5 class="jobSectionHeader"><b>
Benefits</b></h5><p>
Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:</p><ul><li>
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.</li><li>
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.</li><li>
Free counseling services and resources for emotional, physical and financial wellbeing<br>
</li><li>
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)<br>
</li><li>
Employee Stock Purchase Plan with 10% off HCA Healthcare stock<br>
</li><li>
Family support through fertility and family building benefits with Progyny and adoption assistance.<br>
</li><li>
Referral services for child, elder and pet care, home and auto repair, event planning and more<br>
</li><li>
Consumer discounts through Abenity and Consumer Discounts<br>
</li><li>
Retirement readiness, rollover assistance services and preferred banking partnerships<br>
</li><li>
Education assistance (tuition, student loan, certification support, dependent scholarships)<br>
</li><li>
Colleague recognition program<br>
</li><li>
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)<br>
</li><li>
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.</li></ul><p>
Learn more about Employee Benefits</p><p><b><i>
Note: Eligibility for benefits may vary by location.</i></b></p><p><br>
You contribute to our success. Every role has an impact on our patients&rsquo; lives and you have the opportunity to make a difference. We are looking for a dedicated Billing Integrity Analyst RN like you to be a part of our team.</p><h5 class="jobSectionHeader"><b>
Job Summary and Qualifications</b></h5><p></p><p>
The Billing Integrity Analyst Register Nurse (RN) is responsible for determining the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPTs, by reviewing the medical record, facility protocol, and other applicable documentation. This review includes the verification of billing data for accuracy and completeness, following regulatory requirements, in order to resolve edits or exceptions detected during system processing of the claim in Patient Accounting, Relay Health or the payer. Applies modifiers when appropriate based on this review, and/or makes necessary adjustments to patient account charges and/or balances. Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and HCA standards. Uses clinical expertise when applicable to perform charge reviews and/or works on edits that are deemed appropriate for only an RN to be qualified to review and resolve. Combines or splits accounts as appropriate. Serves as a liaison between facilities Administration, Shared Services Center, and ancillary department directors regarding charging issues, clinical documentation issues and revenue opportunities. Provides charge review results and develops and coordinates educational in-services for facility staff related to charging/billing issues. Coordinates retrospective, concurrent, patient requested, and external billing audits. Reviews denial trends for documentation and charging opportunities. Serves as a primary contact for charge related SSC and facility inquiries and issues.</p><p><b>
In this role you will:</b></p><p></p><ul><li>
Analyze and resolve specific billing edits that require an RNs clinical expertise and that are delaying claims from processing in the Patient Accounting and/or Relay Health systems. This includes the verification (and/or correction) of billing data for accuracy and completeness, by following regulatory requirements, and reviewing the medical record, facility protocol, and other applicable documentation. This also includes the application of modifiers and condition codes, as appropriate.
</li><li>Identify charging, coding, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues.
</li><li>Perform charge audits reviews by verifying billing data as compared to documentation and making corrections in Patient Accounting as needed.
</li><li>Analyze charge review findings, provide recommendations to facility ancillary department directors in order to improve documentation, charging flow, and accuracy.</li><li>
Serve as chargemaster liaison to facilitate clinical department education on appropriate charging of CPT codes, Revenue Codes, and communicating with Ancillary Departments to resolve issues. Coordinates updates (activate, inactivate, modification) with Ancillary Departments as necessary
</li><li>Performs assigned charge reviews (governmental, corporate, insurance defense, patient requested, collections, denials, focused review, SPAEs, cosmetics, etc.) by researching documentation, analyzing information, entering all corrections as needed and communicating error trends to provide process improvement opportunities.
</li><li>Review Regulatory and Compliance Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD). Assess impact to Billing Integrity procedures and implement changes as needed. Perform NCD LCD Coverage review when requested.
</li><li>Participate in customer service events at the facility such as facility FECC Committee, new director onboarding, charge education and report charging issues as appropriate.</li></ul><p></p><p><b>
Qualifications:</b></p><p></p><ul><li>
RN or other advanced nursing degree required</li><li>
Active Registered Nurse License or other advanced nursing license required. Compact license for all states accepted.</li><li>
Healthcare experience in an acute care hospital or coding experience preferred. Knowledge of CPT/HCPCS codes or experience in charging or performing charge reviews</li></ul><p></p><p>
<b>Parallon</b> provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.</p><p>
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.</p><p>
&quot;</p><p></p><p><br>
&quot;Good people beget good people.&quot;- Dr. Thomas Frist, Sr.<br>
HCA Healthcare Co-Founder</p>
<p>We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Billing Integrity Analyst RN opening. Qualified candidates will be contacted for interviews. <b>Submit your resume today to join our community of caring!</b></p><p><i>
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</i></p></div>

Billing Integrity Analyst RN

Cedars-Sinai Medical Center

<p></p><div><div><div><div><p><b>Job ID</b> 16108</p>
<p><b>Location</b> Torrance, California, United States
</p><p><b>Job Category</b> Patient Financial Services
</p><p><b>Date posted</b> 04/11/2026</p></div></div><p></p><div><br>
<div></div>
</div></div><div><h2 class="jobSectionHeader"><b>Job Description</b></h2><p>
Align yourself with an organization that has a reputation for excellence! Cedars Sinai was awarded the National Research Corporation&rsquo;s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company&rsquo;s Workplace of the Year. This annual award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We provide an outstanding benefit package that includes health care, paid time off and a 403(B). Join us! Discover why U.S. News &amp; World Report has named us one of America&rsquo;s Best Hospitals.</p><p><b>
What will I be doing in this role?</b></p><p>
The Revenue Cycle Analyst is responsible for the development, assessment and quantification of trends. This will require direct working relationships with management and key staff members, in addition to key members of Finance and Medical Network and Medical Center Departments. The primary duties of this role include:</p><ul><li>
Analyzing trends to determine where variances are occurring and develop reports to assess these variances.</li><li>
Summarizing information, data, and recommendations, and preparing presentation materials. May present findings to management.</li><li>
Making recommendations based upon overall analysis to effectively monitor areas of opportunity/risk.</li><li>
Creating/developing regular and ad-hoc reports.</li><li>
Payor Policy analysis and review.</li><li>
Denial and Revenue Cycle trending.</li><li>
Using independent judgment to resolve issues.</li><li>
Completing complex/special assignments.</li></ul><h2 class="jobSectionHeader"><b>
Qualifications</b></h2><p><b>
Requirements:</b></p><ul><li>
High School Diploma or GED required. Bachelor's degree in finance, economics, business or a related field preferred.</li><li>
A minimum of 1 year of proven experience as an analyst (revenue cycle, data, financial, business, or related) preferred.</li><li>
A minimum of 3 years of proven experience in billing and collections revenue cycle experience required.</li><li>
Experience in Healthcare delivery systems with knowledge of CPT/HCPC, ICD-10 coding, clearinghouse, EDI claims and remittance advice processing, and Epic Revenue Cycle Applications (i.e. ADT/Prelude, Cadence, Resolute PB or HB) highly preferred.</li></ul><p><b><br>
Why work here?</b></p><p><br>
We take pride in hiring the best employees. Our dedicated staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.</p>
</div><div><div><div><b>Req ID</b> 16108</div>
</div><div><div><b>Working Title</b> Revenue Cycle Analyst (Remote)</div>
</div><div><div><b>Department</b> CSRC PB - Group 3 CSMCF</div>
</div><div><div><b>Business Entity</b> Cedars-Sinai Medical Center</div>
</div><div><div><b>Job Category</b> Patient Financial Services</div>
</div><div><div><b>Job Specialty</b> Revenue Integrity</div>
</div><p></p><div><div><b>Overtime Status</b> EXEMPT</div>
</div><div><div><b>Primary Shift</b> Day</div>
</div><div><div><b>Shift Duration</b> 8 hour</div>
</div><div><div><b>Base Pay</b> $77,022.40 - $119,392.00</div></div></div></div><p></p>
<br><div><div><h3 class="jobSectionHeader"><b>Diversity and Inclusion at Cedars-Sinai</b></h3>
<div>
We are caretakers and innovators committed to the pursuit of equitable healthcare. But health equity is not possible without representation. Our commitment to diversity goes beyond demographics or checking boxes. Our people must reflect the diverse identities, experiences and geographies of the communities and patients we serve &ndash; because that&rsquo;s what our patients, colleagues and communities deserve <b>Quality Care and Research&mdash;For All, By All</b>.</div>
</div><div><h3 class="jobSectionHeader"><b>Our compensation philosophy</b></h3>
<div>We offer a competitive compensation package for our employees. The base pay range shown generally applies to the greater Los Angeles area and may vary based on work location. Our range takes into account the wide range of factors that are considered in making compensation decisions, including knowledge/skills: relevant experience and training, education/certifications/licensure; and other business and organizational factors. The base pay range does not include any incentive payments that may be applicable to a role. <b>Pay Transparency Non-Discrimination Provision (PDF) </b>.
</div></div><div><h3 class="jobSectionHeader"><b>Cedars-Sinai is an Equal Employment Opportunity employer.</b></h3>
<p>
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 <b>Applicant_Accommodation@cshs.org</b> 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.</p>
<p>
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.</p>
<p>
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). 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 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.</p></div></div><div></div>

Revenue Cycle Analyst (Remote)

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