Revenue Reimbursement Coordinator

Job description

Centered in beautiful Southern California, Adventist Health Simi Valley has been one of the area's leading healthcare providers since 1965. We are comprised of a 144-bed hospital, home care services and a vast scope of award-winning services located throughout Ventura County. Simi Valley is a suburban area nestled between an urban oasis and the stunning shores of the Pacific Ocean. Bordering Los Angeles allows hiking in the morning and attending film premieres in the evening.
Job Summary:
Adventist Health Simi Valley is seeking a Revenue Reimbursement Coordinator for a full-time position with 8-hour day shifts. We are looking for a qualified and dedicated individual who is able to work onsite at our Simi Valley, CA location.
Supports the Revenue Management department by performing account-level reviews, validating payer adjudication against contract terms, and preparing analytic reports to identify systemic issues, trends, and payer behaviors. Collaborates with Patient Access, Utilization Management, Case Management, Patient Financial Services, Revenue Integrity, and other Revenue Cycle pillars to support denial prevention, process improvement, payer escalations, and reimbursement optimization. Provides detailed account and trend analysis to assist the Director, Revenue Analytics in decision-making.
Job Requirements:
Education and Work Experience:
• Associate’s/Technical Degree or equivalent combination of education/related experience: Required
• Bachelor's Degree: Preferred
• Five years' hospital/medical office experience: Preferred

Essential Functions:
• Performs account-level reviews to ensure timely and full reimbursement according to payer contracts.
• Validates insurance coverage, contract assignment, and authorization status for high-dollar and at-risk accounts. Identifies barriers to clean claims and timely payment; tracks and trends denials, escalating systemic issues to the Director.
• Supports AR Reserve analysis and identifies trends that significantly impact net patient revenues. Prepares supporting reports and documentation for payer escalations, appeals, and Joint Operating Committees.
• Collaborates with Clinical and Revenue Cycle leaders to correct process gaps and prevent recurring revenue leakage.
• Maintains a cooperative and flexible team role, assisting the department with payer escalations and revenue cycle projects as needed.
• Performs other job-related duties as assigned.

Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.