The Analyst II Coder, under the direction of the Revenue Manager/Associate Director, provides support in areas of revenue operations related to production coding, auditing, and training for their designated areas. Under general supervision, applies acquired skills as a revenue cycle analyst to perform charge capture and charge flow, PB coding, charge edit reviews, claim edits, RFIs, support setting up new charging practices/units, and reporting.
Gaining expertise to act as a specialist for designated divisions, manages a diverse range of 1,000‑3,500 procedural code set combinations, plus Evaluation and Management services coding. Demonstrates core coding competency and proficiency in moderately complex duties, including Prof Fee and technical coding. Provides analysis to support department revenue cycle management and improve work queue design and management. Provides education and training to physicians and clinical staff on documentation to ensure compliance with coding guidelines. The Analyst II performs an in‑depth review of physician documentation and is responsible for presenting findings along with recommendations to the department on physician education.
Familiar with all applicable billing and coding regulations and effectively communicates these regulations to all levels of faculty, management, and staff. Applies broad knowledge of hospital operations, different payor guidelines, charge capture and work flows, Epic systems, authorizations, and charge trigger to assign codes based on review of clinical charts, evaluate and resolve denial issues, and identify areas of revenue cycle improvement.
Responsibilities Revenue Cycle Analysis and Production Coding Gain expertise to act as a specialist for at least one to three designated divisions containing eight or more surgical subspecialties. Work proactively with assigned departments to assure appropriate revenue cycle practices and compliance with internal and external regulations.
Perform direct abstract coding from internal and external surgical operative reports, inpatient and outpatient physician evaluation and management notes, and possibly internal or external physician laboratory testing interpretations.
Code moderately complex accounts requiring diverse expertise in charge capture, workflow, hospital operations, authorizations, and revenue cycle.
Manage a diverse range of about 1,000–3,500 coding combinations. Assign and sequence ICD‑10 diagnosis codes, CPTs, and HCPCS codes based on review of inpatient and outpatient clinical documentation and diagnostic results. Apply all applicable modifiers to provide additional information about the medical procedure or service as appropriate by insurance carrier.
Resolve Claims Manager and Epic Edits to ensure correct coding of services provided, including review of documentation for correct coding and E/M leveling, diagnosis coding, bundling issues, modifier usage, etc.
Contribute to small to medium projects analyzing revenue cycle workflows to propose improvements in efficiencies and reimbursement. Assist in developing workflow improvements to maximize revenues.
Assist divisions with defining reporting and documentation requirements. Identify data sources, develop and deliver routine and ad‑hoc reports.
Charge Edit Resolution Review APeX PB Charge Edit and RFI work queues daily and address inquiries from payors that require department review, resolving any claim edits to ensure timely billing.
Proactively review assigned work queues to reach out to faculty and ancillary providers for necessary documentation changes and updates.
Run all necessary reports related to moving assigned charges along in their respective work queues, such as missing charge reports, error reports, and other reports related to charge capture, error resolution and throughput.
Under supervision, analyze charge integrity, reconciliation and charge linkages from ancillary charging systems for the medical center/health system.
Physician and Staff Education Provide revenue cycle coding, charge trigger, authorizations, and billing reimbursement training and education to physicians, allied health providers (AHPs), and clinical staff.
Maintain knowledge of revenue cycle systems, processes and procedures to support other analysts on the team.
Provide feedback at round table discussions with other analysts and staff within the FPRMO.
Analyze and review coding to include research and interpretation of government regulations and payor billing requirements for new and existing services.
Draft memos that provide input and explanation on coding documentation.
Develop reference guides for faculty, AHPs, and staff to assist them in ensuring they document all necessary elements within their notes.
Partner with departmental resident/fellow education programs to develop presentations and materials to teach residents/fellows about proper documentation and how it impacts reimbursement.
Responsible for developing and maintaining the accuracy of educational information posted on internal UCSF websites.
Research and respond to questions from physicians, AHPs, and staff in a timely manner.
Revenue Cycle Compliance Research current trends in healthcare coding, charge capture, claim edits, billing, authorizations, reporting requirements and compliance. Keep departments up to date on regulations and events that impact physician coding and billing.
Review provider documentation to monitor coding accuracy and compliance with all CMS and payor guidelines.
Perform specialized audits of patient medical records and provide documentation feedback to providers in a timely and professional manner.
Identify issues related to billing denials and provide analysis to prevent future coding and billing issues.
Partner with the UCSF Compliance Office in researching how to document for services new to UCSF providers.
Vendor Quality Control Work with vendors to ensure quality coding and billing processes.
Qualifications Bachelor's degree in a related area or four years of equivalent experience/training.
One or more years of revenue cycle professional fee coding experience or equivalent experience/training.
Experience working with professional fee coding CPT, ICD‑10, E/M Documentation Guidelines (1995/1997), CCI edits, Medicare LCDs, state and federal regulations, and payor billing requirements.
Working knowledge of the practices, procedures, and concepts of the healthcare revenue cycle.
Knowledge of billing, collections, charge capture, contractual adjustments, third‑party reimbursements, and cash management.
Knowledge of reporting instruments, metrics, and/or dashboard design.
Detail‑oriented, with demonstrated organizational skills and the ability to manage time efficiently, prioritize tasks, set schedules, and complete projects in a timely and cost‑effective manner.
Proficiency in common database, spreadsheet, and presentation software.
Strong communication skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner.
Ability to summarize and present reports and presentations.
Strong analytical and problem‑solving skills, with the ability to evaluate the effectiveness of workflows and systems.
Interpersonal skills to work effectively in a team environment with internal staff in a wide variety of business and clinical areas.
Knowledge of medical terminology, anatomy, and physiology.
Preferences Prior working knowledge of the EPIC (Apex) system.
Experience working directly with physicians, AHPs, and staff.
Academic medical center experience.
Advanced Coding Certification.
Certification Requirements Certified Professional Coder (CPC), Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or licensure equivalent evaluated by FPRMO management.
Equal Employment Opportunity The University of California 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.
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