Certified Coding Analyst
Columbus, OH
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Job Description
Position Purpose:
Perform review of high dollar claims. Review for appropriate place of service, accurate coding, length of stay, match to authorization, and possible outlier DRG or Stop Loss pricing. Perform coding research. Conduct complex business and operational analyses to assure payments are in compliance with contract; identify areas for improvement and clarification for better operational efficiency resulting in better initiative, contract, and benefit implementation as well as better maintenance long term.
Perform review of high dollar claims for benefit and pricing determination.
Work collaboratively with Finance Department to determine appropriateness of pricing.
Work collaboratively with Medical Management Department to resolve any issues with medical review notes that affect claim pricing
Serve as a technical resource / coding subject matter expert for contract pricing related issues
Responsible for entire cycle of facility claims which includes verifying information on submitted claims, reviewing contracts, eligibility, and authorizations to determine reimbursement, and ensuring payment instructions are sent to claims department for claims payment
Identify key elements and processing requirements based on diagnosis, provider, contracts and policies and procedures utilizing broad based product or system knowledge to ensure timely payments are generated.
Conduct point of service review and resolution of high dollar claims that are pending and/or adjusted incorrectly including review, investigation, adjustment and resolution of claims, claims appeals, inquiries, and inaccuracies in payment of claims.
Collaborate with all departments to analyze complex claims issues and special claim projects.
Qualifications
Healthcare experience REQUIRED
Managed Care strongly PREFERRED
Associate's degree in Business, Health Care Management, Insurance, Healthcare or related field
3+ years of Medical Billing or Physician's office experience.
Extensive knowledge of coding and billing practices for hospitals, physicians and/or ancillary providers as well as knowledge about contracting, claims processing, and provider customer service.
Accepted Licenses/Certifications:
Registered Health Information Administrator (RHIA),
Registered Health Information Technician (RHIT),
Certified Coding Specialist (CCS),
Professional Coder-Payer (CPC-P) certification, Certified Professional Coder (CPC)
Additional Information
Shfit: Monday- Friday; 8AM-5PM
Salary: $41,000-$46,000 + 6% Annual Bonus + Medical Benefits take effect 30 days after start date
Charge Description Master Analyst I
Ohio
Thank you for considering a career at Ensemble Health Partners!
Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!
O.N.E Purpose:
Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.
The Opportunity:
CAREER OPPORTUNITY OFFERING
Bonus Incentives
Paid Certifications
Tuition Reimbursement
Comprehensive Benefits
Career Advancement
This position starts at $57,400.00. Final compensation will be determined based on experience.
By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare.
The CDM Analyst I analyzes and conducts financial reviews to determine charge capture accuracy and comprehensiveness
Job Competencies:
Valuing Differences - Works effectively with individuals of diverse cultures, interpersonal styles, abilities, motivations, or backgrounds; seeks out and uses unique abilities, insights, and ideas. Considers the collective.
Collaboration - Works cooperatively within teams and partners with others, both internally and externally as needed, to achieve success; focuses on the results of the team, not the achievements of one person. It's “All for One and One for All”
Accountability - Accepts personal responsibility and/or consequences of failure and successes, delivering on commitments and refocusing effort when needed. Someone who is willing to step up and own it.
Time Management - Effectively manages personal time and resources to ensure that work is completed efficiently.
Developing Trust - Gains others' confidence by acting with integrity and following through on commitments; treats others and their ideas with respect and supports them in the face of challenges.
Takes Initiative - Takes prompt action to accomplish goals and achieve results beyond what is required; is proactive and pursues relentlessly.
Essential Job Functions:
Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.
1 to 3 years of previous experience in a similar role
Analyzes and conducts financial reviews to determine charge capture accuracy and comprehensiveness
Reviews include observance of operational procedures (enhanced business practices), documentation reviews, validation of data entry and final data capture and other aspects of operational audits
Reviews may be conducted with assistance from clinical staff, coordinate with External and Internal Audit and Compliance staff
Ensures accurate establishment of clinical charges, descriptions and billing codes in the charge master. Ensures accurate cross-walk of charge master details with underlying clinical systems used for charge capture and clinical documentation
Ensures compliance with pricing policy
Leads efforts of multi-disciplinary groups responsible for monitoring and assuring the accuracy and enhancement of hospital net revenue through management of the hospital price master
Leads other multi-disciplinary work groups in revenue enhancement projects including Denial Management and APC Billing committees
Working with groups, also develops new areas of review for future revenue enhancement
Collects, interprets and communicates performance data using various tools and systems, while also using this data to make decisions on how to achieve performance goals
Works with internal and external customers to make key decisions, impacting either the organization as a whole or an individual patient
Works closely with ancillary departments to establish and maintain positive relations to ensure revenue cycle goals are achieved
Provides guidance to and supports clinical departmental needs on questions, process, status and planned changes or updates to the charge master
Manages communication of routine changes to coding and billing protocols and conventions to affected clinical departments
Accountable for resolving inventory-related edits by reviewing and updating charges as necessary to ensure accuracy and compliance.
Assist with implementation of software and providing education to clinical teams on workflow to enhance Chargemaster maintenance workflow.
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
Other Preferred Knowledge, Skills and Abilities:
Experience in the healthcare industry.
Charge Master, EAP and coding experience are highly preferred
Experience in physician and hospital operations, compliance and provider relations
Certifications:
CRCR, required within 9 months of hire (company paid)
Epic Certification preferred
AAPC, or similar certification preferred
Join an award-winning company
Five-time winner of “Best in KLAS” 2020-2022, 2024-2025
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
Energage Top Workplaces USA 2022-2024
Fortune Media Best Workplaces in Healthcare 2024
Monster Top Workplace for Remote Work 2024
Great Place to Work certified 2023-2024
Innovation
Work-Life Flexibility
Leadership
Purpose + Values
Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:
Associate Benefits - We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
Our Culture - Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
Growth - We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
Recognition - We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.
Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.
Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact *****************.
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role's range.
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