3,283 Revenue Cycle Specialist jobs in the United States

Joining Redeemer Health means becoming part of an inclusive, supportive team where your professional growth is valued. Our strength comes from bringing different perspectives and talent to our workforce, spanning PA & NJ. We offer programs that set up new team members for long-term success including education assistance, scholarships, and career training.  With medical and dental coverage, access to childcare & fitness facilities on campus, investment in your retirement, and community events, your career at Redeemer is more than a job.  You'll discover a commitment to quality care in a safe environment and a foundation from which you can provide and receive personalized attention.  We look forward to being a part of your professional journey.  We invite you to apply today.

The Coding Specialist assigns diagnostic and procedural codes consistent with ICD-10 and CPT-4 guidelines, UHDDS sequencing guidelines, CMS coding guidelines, Medicare and Medicaid regulations and the American Hospital Association coding guidelines and  it's publication, Coding Clinic, and AMA's publication, CPT Assistant, for assigned hospital based professional service areas of HRPAS employed practitioners.  Responsible for consistently meeting quality expectations for documentation review, coding,  and meets Redeemer Health's expected productivity standards for the position. Performs assigned duties in accordance with health system   specific coding policies and procedures.  The  Coding Specialist  will assist the assigned HRPAS hospital based providers  with instruction, feedback and documentation review in their particular specialty area.   Responsible for remaining current with latest healthcare technology and coding advice through reading available coding literature, attendance of seminars and in-services , internet research and other educational resources. Collaborates with charge entry personnel to ensure proper entry of diagnostic and billing codes in accordance with guidelines and for assigned areas and for trouble shooting any system or payor rejections for coding and/or documentation purposes.  Performs duties in support of Redeemer Health mission to ensure the highest quality of patient care in an economically sound and efficient manner.

CONNECTING TO MISSION:

All individuals, within the scope of their position are responsible to perform their job in light of the Mission & Values of the Health System.  Regardless of position, every job contributes to the challenge of providing health care.  There is an ongoing responsibility for ensuring that the values of Respect , Compassion , Justice , Hospitality , Holitisic Approach, Stewardship, and Collaboration are present in our interactions with one another and in the services we provide.

   Registered Health Information Administrator or Registered Health Information Technician or equivalent experience, with a Certified Coding Specialist Certification.

·    Must have a minimum of two years of progressive coding and/or billing and registration functions in health care setting and   experience utilizing ICD-9/10-CM and CPT-4 in medical/physician specialties.  

·    Background in Anatomy, Physiology, Clinical Medicine and Medical Terminology.  

·    A graduate of an accredited coding program with certification of completion or successful completion of college credited course work in Medical Terminology, Anatomy & Physiology and Pathophysiology/Disease Processes/Pharmacology required.

·    Works claim edits identified along with compliance of the Medicare Coverage Determinations ( MCD ) , National Coverage Determination ( NCD ) as well as payer specific edits as outlined via contractual agreements particularly around coding matters and when other factors causing the edits are identified refers to proper person to ensure a clean claim is submitted. 

·    Serve as an information rescource and guide to clinicians, champion the need to change coding behaviors and serve as subject matter expert .

·    Submit any issues or trends found within documentation of a physician and/or physician extender to that provider directly or to supervisor.

·    Review to ensure that clinical documentation substantiates the evaluation and management, procedures and modifier selected in accordance with Federal, State and system documentation and coding requirements.

·    Manage and reslove Zero-Pay Worklist , Fully Worked Receivables, complete special project work, review and respond to adjustments/payment data with approval (or initiate appeal) communicate trends and root issues through proper lines of reporting

·    Requires the ability to read and interpret medical terminology and apply coding skills utilizing knowledge of anatomy, physiology and disease processes as well as procedural coding.  

·    Prior experience in coding mentorship and compliance review preferred particularly with physicians/providers. 

·    Must be detail oriented and have sound computer skills. 

·    Experience with review of electronic health records software applications.

LICENSE AND REGULATORY REQUIREMENTS:

Certified Coding Specialist (CCS)

EOE

Redeemer Health is an equal opportunity employer.  We prohibit discrimination in employment due to race, color, gender, religion, creed, national origin, age, sex, sexual orientation, gender identity or expression, disability veteran status or any other protected classification required by law.

Job DescriptionBring your whole self to exceptional care. Cedars-Sinai was tied for #1 in California in U.S. News & World Report's "Best Hospitals 2024-25" rankings, and it's all thanks to our team of 14,000+ remarkable employees. What will I be doing in this role?The Revenue Cycle Specialist III works under general supervision and following established practices, policies, and guidelines of Revenue Cycle Management supporting Hospital, Professional Fee billing and collections. Submit clean, accurate claims to payors and perform timely follow-up to resolve outstanding balances. Positions at this level require expert knowledge, skill and proficiency in CS-Link functions and multi-specialty areas of the revenue cycle. Incumbents have expert knowledge and understanding of regulatory requirements, payor contracts and CSHS policies governing billing and collections and sound interpretation of same. Incumbents are expected to research, analyze and resolve complex cases and problem accounts with minimal assistance. Serves as a technical resource (subject matter expert) to others and may act in the absence of the lead and/or supervisor. This position may be cross-trained in other revenue cycle functions and provide back-up coverage. Primary duties include:Develops and maintains excellent working relationships with Cedars-Sinai Clinical Departments, external clients, and patients, performing duties that include identifying, analyzing, resolving, and responding to our client's inquiries, concerns, and issues, and following up on accounts to ensure resolution. Serves as liaison between CSRC Services and Clinical Departments in the coordination of billing and reimbursement. Responds to patient, insurance company, and other authorized third-party inquiries, including return of calls and research needed to bring account to final resolution.Make recommendations for improved operational processes so that billing information is received from client groups in a timely and accurate manner.Keeps informed of rules and regulations affecting coding and reimbursement by maintaining current CPT and ICD-10 knowledge of assigned areas for accurate assessment of charge review.Inputs specialty or cosmetic charges, creates manual invoices and follows up for payment. Directs billing to the correct entity i.e. (Vision Plan, Personal Family, or Non-Covered). Distributes payments to avoid inaccurate billing to patients. Discusses cash pricing for cosmetic services and cash packages with patients and manages credits for package and/or cosmetic services.Identifies and advances new services for appropriate pseudo-code creation. Identifies possible coding deficiencies through charge/medical record review and coordinates coding review to ensure accurate charge capture, enhancing third-party reimbursement and minimizing audit liability.Review accounts on OCS report with providers to identify balances approved or declined for further collection activity. If approved, initiate collection calls to patients to collect on unresolved balances. If declined, set notification in OCS report format to ensure the account is routed to the appropriate work queue for final resolution.Attends specialty clinical huddles as requested and participates in group problem-solving. Escalation of fee schedule discrepancies and system errors.Participate in specialty clinical huddles and problem-solving discussions.Research and resolve denied or underpaid claims; prepare and submit timely, accurate written appeals with supporting clinical / billing documentations in accordance with payer guidelines.Maintain detailed documentation of appeal activity in Epic, ensuring compliance with internal policies and audit readiness.QualificationsRequirements:High School Diploma or GED required. College level courses in Finance, Business or Health Insurance preferred.Minimum of 4 years of professional and/or hospital revenue cycle billing experience required. Professional billing experience highly preferred.Experience in Pathology preferred.Ability to review and interpret medical documentation, including progress notes, lab results, pathology reports, and other clinical records, to support accurate billing, appeals, and charge validation.Please provide volume of cases worked. Why work here?Beyond outstanding employee benefits (including health, vision, dental and life and insurance) we take pride in hiring the best employees. Our accomplished and compassionate 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.