Under the direction of the Manager and Director of Revenue Integrity, the Revenue Compliance Analyst researches federal and state regulations related to billing, revenue, and CDM. The role performs independent reviews of patient charts and corresponding charges to ensure completeness and appropriateness of revenue cycle functions and charges.
The analyst reviews audit results, makes recommendations for corrective action when issues are identified, and partners with the Business Office, compliance, and clinical teams to support action plans and process changes. This position also resolves problem accounts in accordance with Valleywise Health policies and procedures, helps maintain the CDM to ensure code compliance, assists with annual rate changes, and monitors and distributes regulatory updates related to charging and charge capture.
This is a remote opportunity working within Valleywise Health System, Revenue Management Integrity.
Education
- Bachelor's degree in business or a related field, or equivalent experience in a related field.
Experience
- Minimum of 2 years of progressively responsible healthcare coding experience.
- Preferred: 10 years of progressive experience in the healthcare field with coding experience.
- Experience with chart/bill audits or ability to abstract medical information.
- Working knowledge of revenue cycle processes related to patient billing.
- Thorough understanding of CMS compliance guidelines for hospital coding, billing, and documentation.
- Experience in utilization review/case management and compliance auditing preferred.
Skills and Knowledge
- Strong working knowledge of medical terminology, patient care services, and medical record/chart documentation (inpatient and outpatient).
- Experience with Excel and Microsoft Office Suite required.
- Experience with Epic hospital billing and CDM systems desired.
- Strong analytical, writing, and communication skills.
- Ability to manage multiple priorities and deadlines using independent judgment.
- Effective interpersonal skills and the ability to inform, advise, and instruct.
- Ability to read, write, and speak English effectively.
Specialized Training
- Epic certification in HB Charge Description Master and Cost Center assignment required within 6 months of hire.
- Preferred: certifications related to business, clinical, or financial applications/systems.
- Preferred: professional clinical licensure (for example, RN, Radiology, Laboratory, or Pharmacy) if supporting clinical application systems.
Benefits
- Medical, dental, and vision plans
- Flexible spending accounts
- 100% retirement match in the Arizona State Retirement System (ASRS)
- Paid time off and paid holidays
- Sick and extended illness bank
- Tuition reimbursement programs
- Additional employee benefits
Location
Arizona, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$79,914 - $117,874
Remote work allowed
Yes
Posted
1 month ago