Integrity Specialist – Complex Specialties

This is a fully remote position, open to applicants in Alabama, +32 more states.

📋 Description

• Analyze and resolve coding-related PB denials utilizing CPT, HCPCS, ICD-10-CM, and modifiers.

• Identify root causes, patterns, and trends associated with denial and rejection codes.

• Collaborate with billing, coding, and payer teams to amend, resubmit, and prevent denied claims.

• Conduct chart reviews to confirm documentation aligns with billed services.

• Prepare and facilitate appeals by researching payer guidelines, coding standards, and coverage policies.

• Ensure coding is accurate and compliant, following official guidelines and payer requirements.

• Track, document, and report on denial resolutions, appeal results, and coding quality issues.

• Support compliance, quality assurance, and revenue integrity initiatives through monitoring and issue escalation.

• Educate clinicians, coders, and staff by sharing insights and providing targeted training based on denial trends.

• Contribute to strategies for denial avoidance, work queue optimization, CARC code mapping, and technology enhancements.

⛳️ Requirements

• Associate degree or equivalent education and experience is required.

• A coding credential is mandatory.

• Coding Certification from AHIMA or AAPC along with relevant experience is necessary.

• A minimum of 4 years of experience in expert-level professional coding or hospital-based coding is required.

• Experience with revenue cycle processes, health information workflows, and medical record auditing is essential.

• Advanced knowledge of third-party reimbursement programs, state and federal regulatory matters, national and local coverage decisions, research-related restrictions, and ICD-10-PCS/CM, CPT, and HCPCS coding classification systems is needed.

• Extensive understanding of medical terminology, anatomy, and physiology is required.

• Ability to identify coding discrepancies and offer recommendations for improvement is essential.

• Capacity to analyze trends and data and present them in a statistical reporting format is required.

• Advanced knowledge of care delivery documentation systems and medical record documents is needed.

• In-depth knowledge of Medicare, Medicaid, and commercial payer coding guidelines is essential.

• Proficiency in Microsoft Office, video and web conferencing tools, email, electronic coding, and EHR systems or applications is necessary.

• Strong interpersonal and communication skills are required.

• Excellent organization and prioritization skills are essential.

• Advanced analytical skills and attention to detail are necessary.

• Ability to work independently, exercise judgment, and make decisions is required.

• Capability to meet deadlines in a fast-paced environment is essential.

• Critical thinking, creativity, problem-solving, and decision-making skills are required.

• Willingness to travel, with consideration for road and weather hazards, is necessary.

• A second specialty credential is preferred.

🏝️ Benefits

• Benefits Eligible.

• Competitive compensation.

• Premium pay options such as shift differentials, on-call pay, and more based on the teammate's role.

• Incentive pay available for select positions.

• Opportunities for annual salary increases based on performance.

• Paid Time Off programs.

• Comprehensive medical, dental, vision, life, and Short- and Long-Term Disability benefits.

• Flexible Spending Accounts for eligible healthcare and dependent care expenses.

• Adoption assistance.

• Paid parental leave.

• Defined contribution retirement plans with employer matching.

• Financial wellness programs.

• Educational Assistance Program.

• Career development programs.

• Well-being programs.