Job Details

Overview

Remote Denials, Credit / Refund Analyst. The role works in partnership with department leadership, vendors, and internal and external customers to resolve and/or improve hospital patient account revenues related to hospital billing and collections. Provides team support as a hospital billing and follow up subject matter expert, performing patient account audits, supporting team training tasks, and participating in root-cause analysis in accounts receivable workgroups.

Performs department data analytics in support of trending, root cause analysis, and proactive identification of hospital accounts receivable risks. Interprets complex hospital commercial, managed care, and government payer contracts, including reimbursement methodologies and payment terms, to audit patient accounts, validate claim adjudication, and identify underpayments, overpayments, and systemic contract issues. Presents findings and recommendations to Revenue Cycle leadership to support operational decision-making and denial prevention strategies.

Monitors payer guideline changes in partnership with department leadership. Analyzes and presents findings of hospital patient account system workflow and/or claim adjudication issues to Revenue Cycle Leadership with recommendations to remediate or resolve. Creates, supports, and partners in design for system tickets supporting hospital clean claim submissions and workflow optimization. Develops hospital account data reports required for accounts receivable analysis in collaboration with department leadership. Provides department administrative support creating and gathering data reports, insurance or vendor correspondence related to patient account management, and co-facilitates team meetings related to insurance claim processing and/or workflow changes. Participates in development and delivery of hospital billing and follow-up training and workflows.

MINIMUM QUALIFICATIONS

• Seven (7) years of related experience, education/training, OR a Bachelors degree in a related area plus three years of related experience/training. Related experience includes hospital billing, denials management, credit balance/refund adjudication, Epic HB/PB claims workflows, payer policy interpretation, contract review, and coding/billing regulatory compliance.

• Thorough knowledge of healthcare revenue cycle practices, procedures, and concepts, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.

• Thorough understanding of the issues, processes, reporting instruments, metrics, analytics, and tools used to measure and analyze the revenue cycle.

• Detail oriented with strong time management, the ability to manage multiple priorities, and the ability to address complex, urgent issues as they arise.

• Strong skills in report development, dashboard design, and software tools specific to healthcare revenue cycle management; proficiency with databases, spreadsheets, and presentation software.

• Strong communications skills, with the ability to interpret and convey complex clinical finance information clearly. Ability to prepare compelling reports and presentations.

• Strong analytical and problem-solving skills, with the ability to evaluate workflows and propose innovative solutions.

• Strong interpersonal skills with the ability to collaborate on complex projects in a diverse, cross-functional team environment.

• Proven ability to work with managers as a technical resource, providing recommendations on regulatory changes and industry trends in revenue cycle management.

PREFERRED QUALIFICATIONS

• EPIC experience.

• Experience performing medical record review and drafting hospital-level appeals.

• Experience evaluating payer refund requests and drafting formal refund denial/acceptance determinations.

• Hospital billing, credits/refunds, and follow-up tasks (including follow-up work queues) experience.

• Working knowledge of hospital commercial contracts, billing and coding guidelines.

• Experience auditing hospital patient accounts in relation to Revenue Cycle.

• Experience training others.

• Strong organization and time management skills to support patient accounting daily operations.

SPECIAL CONDITIONS

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.

Pay Transparency Act

Annual Full Pay Range: $79,200 - $143,400 (will be prorated if the appointment percentage is less than 100%).

Hourly Equivalent: $37.93 - $68.68.

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements.

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Additional Notices

If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs. Federal, state, or local public health directives may impose additional requirements.

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 is the only academic health system in the San Diego region, providing care in patient care, biomedical research, education, and community service. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration, 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.

UC San Diego is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law. For the Anti-Discrimination Policy:

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information. UC San Diego Health maintains a drug-free environment; employees may be subject to drug screening.

Misconduct Disclosure Requirement: As a condition of employment, the final candidate will be required to disclose if they have had any final administrative or judicial decisions within the last seven years determining misconduct, or filed an appeal of a finding of substantiated misconduct with a previous employer. Examples of misconduct include violations of policies governing employee conduct, including sexual harassment, sexual assault, or discrimination. References: UC Sexual Violence and Sexual Harassment Policy; UC Anti-Discrimination Policy; Abusive Conduct in the Workplace.

UC San Diego and the University of California are Equal Opportunity Employers.