Revenue Control Analyst job vacancy in The County of Santa Clara – Santa Clara Valley Medical Center, (Santa Clara, CA)

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We got a new job details in The County of Santa Clara – Santa Clara Valley Medical Center & they are Hiring Candidates for Revenue Control Analyst

Job Details
Company Name :
The County of Santa Clara – Santa Clara Valley Medical Center
Company Location :
Santa Clara, CA
Job Position :
Revenue Control Analyst
Job Category :
Jobs in California

Job Description :

Under supervision, to support and review patient records and billing information; or to coordinate, monitor, review, analyze and implement modifications to the Charge Description Master to ensure all services are captured and billed appropriately; and to perform analytic studies and projects related to coordination, implementation, and maintenance of Santa Clara Valley Medical Center’s rate structure, professional fee coding, compliance and education, and to support management in projects related to revenue generation, enhancement and control.

COVID 19 Risk Level: Lower Risk

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Typical Tasks

Reviews services performed with the Santa Clara Valley Health and Hospital System to ensure appropriateness of fees charged, and the accuracy of service coding by utilizing Common Physician Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and Relative Value Studies (RVS);
Coordinates and maintains rate files (or assists) for all revenue producing departments;
Monitors changes in third party payment rates on a consistent basis in order to keep the medical center’s rates current with market prices for services performed;
Makes comparative analysis of technical data;
Provides rate setting, revenue generation, and professional fee coding expertise to department managers, nurses and physicians by training and monitoring the charging function, assisting in the development of departmental charge documents, providing consultation when changes to the charging system occur, and providing ongoing provider education;
Reviews and monitors all physician contracts which utilize gross hospital revenue as a basis for physician reimbursement, and insures the accuracy of the physician payments by reflecting the correct payment percentage in the hospital rate file;
Meets with billing staff to resolve (or assist in resolving) billing issues relating to the Charge Description Master and denials management;
Coordinates and responds to inquiries from the medical staff, public and other hospitals regarding the price quotes for medical services;
Works to develop provider education curriculum and training materials; including new governmental and third party payor requirements;
Develops effective relationships with hospital departments, clinics and medical staff, as well as peers at other similar institutions and professional organizations;
Conducts surveys, studies, and other research projects necessary for rate analysis, rate setting, and charging practices;
May conduct audits for coding compliance and provides feedback and education to departments and/or providers;
Works with accountants and vendor of computerized billing system/accounting services to produce statistical reports for third party payers and government agencies;
Analyzes and interprets existing, new and proposed State and Federal legislation and the impact on billing/claiming, financial reporting and programs:
Meets with Information Services Department to assist in resolving computer system problems;
Compiles information and prepares reports;
May be assigned as a Disaster Service Worker, as required;
Performs related duties as required.

Employment Standards

Possession of one of the following certifications: Certified Professional Coder (CPC), Certified Medical Coder (CMC) or Certified Coding Specialist – Professional (CCS-P).

Training and Experience Note: The knowledge and abilities to perform this function are acquired through training and experience equivalent to the completion of sixty (60) semester units from an accredited college and four (4) years of experience as a Health Services Representative, Patient Business Services Clerk, Medical Administrative Assistant, Health Information Clerk, or comparable classification within the health care field.

Knowledge of:

Rate setting models and procedures necessary to optimize revenue generation objectives and meet the requirements of third party payers;
Hospital mainframe and professional fee information systems relating to charging, billing, and financial reporting;
Principles and practices of professional fee coding compliance;
Personal computers and software applications to produce revenue generations projects and objectives;
Sources of information about legislation involving hospital rate reimbursement structures;
Principles of organization and administration;
Statistical research techniques and procedures;
Communication techniques for gathering, evaluating, and conveying information;
Medical terminology, relating to diseases and related treatments;
Current Procedural Terminology (CPT) coding, Healthcare Common Procedure Coding Systems (HCPCS), Relative Value Studies (RVS), ICD9 and other medical coding resources;
Fiscal policies, procedures, and regulations relating to services performed;
Regulations, laws, and reporting requirements common to the operation of California hospitals;
Medicare, Medi-Cal and third party payer procedures common to medical billing;
Data collection techniques.

Ability to:

Initiate, plan, and complete work assignments with limited direction and supervise subordinate staff;
Develop and implement an effective work flow process to maximize productivity;
Develop education curriculum and training materials;
Prepare reports supporting recommendations;
Define problem areas;
Plan, coordinate, and initiate action necessary to implement recommendations or changes required by third party payers and legislative action;
Collect, assemble, analyze, and present technical data;
Speak effectively and participate in group meetings;
Follow oral and written directions;
Interact with hospital and other personnel with issues related to hospital rates, reimbursement requirements, professional fee coding compliance, and other revenue control issues with third party payer representative, monitors, and the public;
Maintain effective working relationships with hospital staff, including department managers, physicians, and hospital administration;
Learn new information and more complex tasks involved in hospital revenue control;
Function under stress of strict deadlines or confrontational situation;
Deal cooperatively, tactfully, and effectively with those contacted in the course of work.

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