Medical Billing/Revenue Cycle Health Analyst - $46.90/hr

Healthcare Staffing Professionals has an immediate need for a Medical Billing/Revenue Cycle Health Analyst to support the Public Health Enhanced Care Management Program. ECM-CMS program will serve this particularly vulnerable ECM populations of focus (POFs): Children/Youth Enrolled in California Childrens Services (CCS) with Additional Needs Beyond the CCS Condition. DPHs ECM-CMS team has extensive experience and expertise in working with this population for intensive care management and care coordination. It is anticipated that some CCS clients are also in the Child Welfare System. These clients, when encountered will be included in the initial launch. After the initial successful program launch, ECM-CMS will consider growth to fully serve both POFs. Intensive care management will be provided based on comprehensive care plans that aim at addressing the need for overall care management for the multiple systems with which the child/youth and family interact. The positions will begin immediately upon acceptance and employment clearance and are initially funded through 8/31/26. Pay Rate: $46.90/hr Benefits: Paid Holidays, Paid Sick Time, PTO Healthcare Employer Fully Funded Healthcare (Anthem Blue Cross), Dental and Vision, Life Insurance from Initial Start Date. Shifts: Full time, M-F, 8am to 5pm in El Monte PROPOSED DUTIES: The Health Analyst (HA) is a mid-level manager who oversees data, billing and reimbursement platforms, workflows and processes in the DPH/CMS ECM program. The position will help lead revenue cycle management at DPH/CMS ECMa process that spans patient and billing data entry by ECM staff to reconciling receipts of Managed Care Plan (MCP) reimbursements for ECM services. DPH/CMS intends for its ECM program to become sustainable following its first year of operation, which requires an effective health information processing workflow that seamlessly converts clinical data to claims elements. The HA manages the entry of patient data that generates billing information from which the third-party can generate and reconcile claims. This position will supervise the patient data entry and coding staff and functions (Senior Typist-Clerks [STCs]), serve as primary liaison to ORCHID (electronic health record EHR), and partner with ECM revenue collections staff to optimize accounts receivable operations and fiscal/financial forecasting. Senior Typist-Clerks (STCs) will support care and revenue cycle management functions to maximize efficiency, curtail costs and optimize administrative effectiveness. Extensive integration of STC support in CMS California Childrens Services (CCS) and Child Welfare Public Health Nursing (CWPHN) programs has demonstrated that STCs can assume duties (e.g., compiling medical records, documenting client encounter and utilization data, transferring notes into electronic record-keeping platforms, etc.) and free up professional staff (nurses and social workers) to devote more of their time providing clinical care and in direct client services.STCs will be deployed to support the medical case worker staff, and to support health information processing and revenue collection (revenue cycle management), primarily for health information data entry. In addition, two STCs will be assigned to the Health Analyst to transfer patient-level health data from CMSNet (CCS) into ORCHID, the ECM EHRS. EXAMPLES OF DUTIES: The Health Analyst is critical to DPH/CMS ECM revenue cycle management process because s/he supervises the intermediary health information processing (medical coding) role that bridges patient care (front-end patient care management) to accounting (back-end revenue collection). In this position, specific duties include but are not limited to:Supervises staff (STCs) who enter necessary patient-level information, assessment and coding data into the ECM EHR (ORCHID) Oversees third-party claims submission and billing management (third-party vendor performs billing and claims submission and disposition from ORCHID), and Partners with the DPH/CMS finance team and the billing vendor to adjudicate claims denials, reconcile billing errors, verify revenue collection, and remedy underpayments. Requirements: Four years of experience in a staff capacity analyzing and making recommendations for the solution of problems of organization, program, procedure, budget, or personnel -OR- one year of highly responsible administrative or staff experience assisting in research and analysis of, and making recommendations regarding the use and deployment of resources and the implementation and refinement of operations and programs; and A valid California Class C Driver License or the ability to utilize an alternative method of transportation when needed to carry out job-related essential functions