Clinical Revenue Analyst - Hybrid/Remote - 121082

This position will work a hybrid schedule which includes a combination of working both onsite at La Jolla and remote.

The Department of Orthopaedic Surgery at UC San Diego School of Medicine is a diverse patient, research, education, and academia focused, high-performing Department with a commitment to quality, collaboration, innovation, and continuous improvement. Orthopaedic Surgery provides treatment for disorders of the musculoskeletal system, offering comprehensive and innovative services. The Department offers a full spectrum of musculoskeletal clinical care, specializing in foot and ankle, hand and microvascular surgery, joint reconstruction, physical medicine and rehabilitation, spine, sports medicine, orthopaedic oncology, and trauma. Research expertise includes advancements in muscle metabolism and physiology, neuromuscular bioengineering, intervertebral disc, and musculoskeletal physiology and epidemiology. The Department supports an ACGME accredited residency program and fellowship in hand and microvascular surgery, as well as fellowship programs in joint reconstruction, spine, and trauma.

Under the direction of the Vice Chair for Administration, the Clinical Revenue Analyst will work independently and serve as an expert on professional fee coding and revenue management, funds flow management, provider education and documentation, and efficiency enhancement for the Department of Orthopaedic Surgery. Incumbent reviews abstracted provider education to audit ICD-10 and CPT codes for E&M, injections, surgeries, and other services provided by the Department.

The coder is responsible to accurately interpret notes/diagnoses and to convert them into CPT/HCPC/ICD10 codes as appropriate in order to fully capture all billable services. Position to keep up to date and current CPT, and individual insurance company guidelines, as well as orthopedic coding guidelines, and examines claims for accuracy and compliance per all billing and coding guidelines.

Clinical Revenue Analyst to educate and train providers and clinical staff on guidelines and clinical documentation requirements, annually or as needed. Serves as a liaison on behalf of the Department with the Physician Group and Health System to mitigate queries and resolve billing issues and/or delays. Assesses bill areas and funds flow for accuracy. Facilities charge capture, monthly and/or quarterly case review with providers, and provides feedback and guidance to providers and ensures compliance to governmental, UC, compliance, and payor guidelines.

Position to oversee billing credentialing, clinical productivity reporting, and professional billing and revenue reports. Clinical Revenue Analyst manages related operations and projects, acting as a trusted advisor and partner to provider organizations to support clinical excellence and optimal revenue cycle and funds flow performance. Ensures all charges are captured by utilizing reports or processes on a daily basis and following up accordingly. Performs coding quality reviews and productivity reporting on a monthly basis. Recommend, specify, develop, and supervise the implementation of policy changes that affect department Professional Fee income. Completes other duties as assigned.

• Seven (7) years of related experience, education/training, OR a Bachelor's degree in related area plus three (3) years of related experience/training

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).

• Strong skills in CPT, ICD-10 and HCPC coding applications

• Thorough knowledge of financial analysis and reporting techniques, and / or human resources policies and procedures for staff and academic employees. Experience in a provider educator role and the completion of billing packets and associated training.

• Knowledge of a variety of administrative operational activities such as event planning, basic fundraising processes, risk management planning, website design, accounting and payroll, and contracts and grants regulations and guidelines.

• Effective interpersonal skills including verbal and written communication, active listening, critical thinking, persuasiveness, advising and counseling skills. To include decision making and problem solving skills for a complex surgical department and for customers at all levels including physicians and staff.

• Strong skills in short-term planning, analysis, problem-solving, and customer service. With the ability to track trends and make recommendations based on those results.

• Thorough knowledge of University rules and regulations, processes, protocols and procedures for budget, accounting and fund management, and / or personnel management.

• Solid knowledge of common University-specific computer application programs. With proven experience and working know of epic, billing software and spreadsheet programs such as excel.

• Proficient knowledge of claims requirements for all insurance carriers. This is to include billing, documentation and follow-up criteria inclusive of appeals process.

• Experience creating budgets and tracking productivity and other clinical billing metrics with the ability to analyze results and recommend solution.

• Certified Professional Coder with excellent knowledge in CPT, ICD-10 and HCPC coding applications.

• Experience in reviewing physician documentation to assign the correct diagnosis and procedural codes for all encounters

• Masters degree in related field with and/or five (5) years relevant experience.
• Certified Orthopaedic Surgery Coder.
• Certified Orthopaedic Surgery Coder (COSC).

• Employment is subject to a criminal background check.
• Must be willing and able to travel.
• Must be able to work various hours and locations based on business needs.

Job offer is contingent on successful engagement in the UC COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health Sciences is comprised of our School of Medicine, Skaggs School of Pharmacy and Pharmaceutical Sciences, The Herbert Wertheim School of Public Health and Human Longevity Science, and our Student Health and Well-Being Department. We have long been at the forefront of translational - or "bench-to-bedside" - research, transforming patient care through discovery and innovation leading to new drugs and technologies. Translational research is carried out every day in the hundreds of clinical trials of promising new therapies offered through UC San Diego Health, and in the drive of our researchers and clinician-scientists who are committed to having a significant impact on patient care. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

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UC San Diego Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. For the complete University of California nondiscrimination and affirmative action policy see:

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UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.