FTE1
Scheduled Bi-Weekly Hours80
Work ShiftDay: 8 hours
Job DescriptionThe Revenue Integrity Analyst is responsible for maintaining El Camino Health's Charge Description Master (CDM) while also supporting broader revenue integrity functions across the organization. This position ensures accurate charge capture and billing by providing subject matter expertise in coding, documentation review, and compliance with CMS and commercial payer requirements.
In addition to traditional CDM maintenance duties (e.g., CPT/HCPCS coding, UB-04 Revenue Code assignment, and pricing validation), this role supports clinical departments in resolving National Correct Coding Initiative (NCCI) and Medically Unlikely Edit (MUE) denials, reviewing supporting documentation in the electronic health record (Epic), and advising on the appropriate application of billing modifiers and corrections.
This position requires certification as a Certified Professional Coder (CPC) or equivalent and involves close collaboration with clinical stakeholders, IT, and Revenue Cycle departments to ensure compliant and complete revenue capture
Qualifications- Maintain CDM for all required elements, including but not limited to assignment of applicable CPT/HCPCS coding, UB-04 Revenue Codes, and appropriate pricing.
- Maintain and oversee professional fee schedules for hospital-affiliated clinics.
- Ensure that El Camino Health's CDM remains compliant with changing billing and coding updates made by CMS, American Medical Association (AMA) and other government and commercial insurance payers, as applicable.
- Review and resolve NCCI and MUE edits in collaboration with coding, clinical, and billing teams, determining appropriate modifier usage and correction strategies based on documentation.
- Read and interpret clinical documentation in the EHR to validate submitted charges and support resolution of coding discrepancies.
- Partner with clinical and ancillary departments to provide education, direction, and guidance on accurate and compliant charge capture practices.
- Support audits and charge validations to identify opportunities for revenue recovery and compliance improvement.
- Collaborate with IT and application teams (e.g., Epic) to ensure CDM changes are integrated with front-end charge capture tools and workflows.
- Monitor regulatory changes and payer guidance to proactively maintain CDM accuracy and minimize claim denials related to coding or documentation issues.
- Other duties as assigned
Qualifications- High School Diploma or equivalent. Bachelor's degree in business, Health Information Management (HIM), or Healthcare-related field preferred.
- 3 years of combined experience in hospital CDM management, charge capture, or revenue integrity roles.
- Minimum two years' experience with professional or facility coding, modifier usage, and claim edit resolution.
- Experience interpreting clinical documentation in the EHR and applying coding principles to support accurate billing.
- Proficient in Microsoft Excel, Word, and Epic (or comparable EHR/CDM systems).
- Highly collaborative and able to work cohesively in a dynamic team environment.
- Strong understanding of hospital's comprehensive revenue cycle.
- Strong communication and interpersonal skills; able to work well with all levels in the organization, including Senior Leadership.
License/Certification/Registration Requirements Required: Certified Professional Coder (CPC) from AAPC
Preferred: Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician-based (CCS-P) from AHIMA
Must maintain active certification status in good standing throughout employment
Ages of Patients ServedN/A
Salary Range:$49.42 - $74.13 USD Hour
The Physical Requirements and Working Conditions of this job are available. El Camino Health will provide reasonable accommodations to qualified individuals with a disability if that will allow them to perform the essential functions of a job unless doing so creates an undue hardship for the hospital, or causes a direct threat to these individuals or others in the workplace which cannot be eliminated by reasonable accommodation.Sedentary Work - Duties performed mostly while sitting; walking and standing at times. Occasionally lift or carry up to 10 lbs. Uses hands and fingers. - (Physical Requirements-United States of America)
