Revenue Cycle Specialist – Revenue Integrity, Pathology

This is a fully remote position, open to applicants in New York.

📋 Description

• Conducts retrospective coding reviews of denied charges for physician services.

• Evaluates medical records for completeness and accuracy to guarantee that documentation supports the billed services and adheres to all billing standards.

• Makes necessary corrections to charges.

• Analyzes invalid denial trends, payer-specific carrier submission requirements, and system optimization.

• Engages in extensive follow-up to investigate and resolve trends in payment denials.

• Resolves outstanding accounts by utilizing ancillary applications and websites to retrieve medical documentation.

• Researches and interprets payer contract terms, compiling the necessary supporting documentation templates for appeals.

• Ensures that denial reviews are performed promptly.

• Keeps policies and procedures updated, along with knowledge related to managed care and third-party payors.

• Participates in mandatory compliance training both annually and on an ongoing basis.

• Completes Continuing Education Units required to maintain certification status.

• Aids in training existing and new employees on the use of systems and departmental policies and procedures.

• Performs other related duties as assigned.

⛳️ Requirements

• High school diploma or GED in a relevant field.

• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) from AHIMA or AAPC.

• Approximately 3-5 years of experience in physician billing, particularly in accounts receivable and collections.

• Previous experience with an eMR system.

• Proficient knowledge of medical terminology.

• Familiarity with third-party reimbursement processes.

• Competence in Microsoft Excel and other reporting software to sort, filter, summarize, and identify various accounts receivable trends.

• Pathology experience is preferred.

🏝️ Benefits

• Comprehensive health benefits package.

• Opportunities for professional development and continuing education.

• Supportive work environment with a focus on teamwork.

• Flexible work schedule options.