Claims Review Specialist - Accounting/ Revenue Integrity Analyst

Ampcus - Los Angeles, CA

Full-time

Los Angeles, CA

Professional, Scientific, and Technical Services

About the position

The Claims Review Specialist - Accounting/Revenue Integrity Analyst position at Ampcus, Inc. involves a critical role in enhancing the operational and financial effectiveness of a complex health system. The specialist will leverage their extensive knowledge of the revenue cycle to address various revenue issues, analyze financial data, and ensure compliance with regulations. This role requires a detail-oriented professional who can effectively communicate and collaborate with different departments to improve revenue cycle operations.

Responsibilities

• Analyze complex financial data
• Identify trends in revenue cycle operations
• Summarize data and present reports to leadership
• Serve as liaison with departments to thoroughly define reporting and information requirements
• Evaluate revenue cycle workflows to identify areas for improvement
• Oversee charge integrity, reconciliation, and charge linkages from ancillary charging systems
• Train patient financial services units on revenue cycle systems, processes and procedures
• Maintain compliance with government regulations, reimbursement issues, etc.
• Analyze hospital billing claims within the EHR and claim scrubber system
• Resolve claim errors, edits, and other holds
• Work with clinical and ancillary operational departments on correct coding, billing, and charging principles

Requirements

• Bachelor's degree in business, finance or related field
• CPC-H, CPC, or CCS coding certification
• Five or more years of experience with hospital billing systems and third-party billing requirements
• Experience in revenue integrity operations, clinical charge capture, charge master, or revenue cycle operations
• Proficiency with Microsoft Excel
• Knowledge of Tableau Reporting dashboards
• Understanding of Medicare/Medi-Cal claims processing guidelines
• Experience with EPIC EHR, Cirius Claim Scrubber, or other EHR system
• In-depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle
• Strong analytical and problem-solving abilities
• Excellent communication, interpersonal, and collaboration skills
• Proficiency in the use of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and revenue codes