Revenue Integrity Coding Billing Supervisor

This is a fully remote position, open to applicants in United States.

📋 Description

• Investigate, monitor, and rectify issues related to health care claim billing errors and denials.

• Support the Revenue Integrity Program to enhance compliance with government, managed care, and third-party payer billing and reporting standards.

• Collaborate with the CRCM project team and client stakeholders to achieve continuous process enhancements and Revenue Integrity KPIs.

• Review and address assigned Medicare and third-party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber hold edits, and claim denials.

• Resolve CCI, MUE, Medical Necessity, and other claim-level billing edits.

• Examine clinical documentation and diagnostic results to validate and apply ICD-10, CPT, HCPCS codes, and coding modifiers.

• Address Revenue Integrity-specific denials within the Guidehouse METRIX system.

• Ensure that coding and billing practices align with Federal and State regulations.

• Stay updated on Medicare, Medicaid, and third-party payer billing compliance requirements.

• Work collaboratively with various departments and professionals to resolve revenue integrity challenges.

• Supervise and train Revenue Integrity staff to guarantee appropriate reimbursement and compliance.

• Develop and uphold client policies and procedures.

• Serve as the liaison between Revenue Integrity teams and clients, clearly communicating expectations.

• Review the work of new Revenue Integrity team members for compliance and quality before release.

• Monitor staff productivity, workload, and workflows to meet turnaround expectations.

• Identify staffing requirements and adjust schedules accordingly.

• Complete employee timesheets and time-off requests in the payroll system.

• Assist in interviewing and hiring competent Revenue Integrity staff.

• Participate in monthly conference calls with clients and the Revenue Integrity team.

• Provide daily support to address facility-related issues and inquiries.

• Evaluate team member competencies and offer ongoing training and development.

⛳️ Requirements

• Bachelor's degree or equivalent of 5 years of relevant job experience.

• Minimum of three years of management experience required.

• AAPC or AHIMA coding certification is mandatory.

• Experience in ICD-10, CPT, and HCPCS Level II coding is essential.

• Expertise in assessing medical necessity of services rendered and billed based on provider/clinical documentation.

• Comprehensive knowledge and application of Medicare, Medicaid, and third-party payer UB-04 billing and reporting requirements.

• Experience in resolving CCI, MUE, and Medical Necessity edits associated with claims.

• Proficient in determining accurate medical codes for diagnoses, procedures, and services performed in an outpatient setting.

• Familiarity with current code bundling rules and regulations.

• Proficient in compliance and reimbursement under outpatient grouping systems such as Medicare OPPS and Medicaid or Commercial Insurance EAPG's.

• Knowledgeable about hospital charge description master coding systems and structures.

• Excellent verbal, written, and interpersonal communication skills.

• Proficient in Word and Excel.

• Ability to deliver accurate assigned work products within designated time frames.

• Experience in hospital medical billing and auditing is preferred.

• Willingness to travel up to 10% of the time.

• No security clearance is required.

🏝️ Benefits

• Medical, Rx, Dental & Vision Insurance.

• Personal and Family Sick Time & Company Paid Holidays.

• Position may qualify for a discretionary variable incentive bonus.

• Parental Leave.

• 401(k) Retirement Plan.

• Basic Life & Supplemental Life Insurance.

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts.

• Short-Term & Long-Term Disability.

• Tuition Reimbursement, Personal Development & Learning Opportunities.

• Skills Development & Certifications.

• Employee Referral Program.

• Corporate Sponsored Events & Community Outreach.

• Emergency Back-Up Childcare Program.

• Flexible benefits package.