Revenue Integrity Coding Specialist

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

📋 Description

• Assist in high-value projects that align with strategic business objectives.

• Enhance Days Sales Outstanding (DSO) and reduce denial rates through timely troubleshooting.

• Address external charge code audits and increase payer audit resolution rates.

• Correct coding errors to minimize denials and mitigate revenue loss.

• Investigate payer reimbursement guidelines and assess their effects on coding practices.

• Utilize machine learning tools to proactively identify trends monitored by health plans.

• Recognize exceptions and outliers, validating machine learning results through manual reviews.

• Employ PowerBI and Advanced Excel to pinpoint and confirm trends.

• Inform state Medical and Clinical Leaders about opportunities for documentation improvement.

• Collaborate with Revenue Cycle Leaders on proactive measures and responses to coding-related denials and exclusions.

• Implement the Coding Informatics Payer Audit Standardization initiative.

• Act as a liaison between internal departments and external vendors regarding medical records submission protocols.

• Observe payer audit trends and refine workflows and processes.

• Maintain departmental documentation and procedural guidelines.

• Monitor the effectiveness of payer audits, company performance, and recoupments.

• Deliver monthly scorecards to the Sr Director and report on progress towards performance goals.

• Develop strategies to enhance efficiency, customer satisfaction, and operational effectiveness.

• Identify workflow inefficiencies and implement solutions to boost productivity, quality, and operational efficiency.

• Report to the Sr. Manager, Revenue Integrity.

• Engage in projects and initiatives, taking on additional responsibilities to support the team and its mission.

⛳️ Requirements

• Successfully passed a Medical Coding Certificate Exam (CPC, CPC-A, CCS, or CPMA), or possess at least 4 years of experience in coaching clinical coding and applying it within a healthcare environment.

• Strong command of medical terminology.

• Advanced understanding of payer audits, rebuttals, and redeterminations.

• Medical Coding Certificate (CPC, CPC-A, or CCS) is preferred.

• Equivalent certification and/or degree may be accepted in place of Medical Coding Certification.

• Advanced skills in Microsoft Excel, particularly in data analysis.

• Proficient in Microsoft Word.

• Experience with Electronic Medical Records.

• Familiarity with Practice Management Software.

• Knowledge of HIPAA regulations.

• Understanding of mental/behavioral health is preferred.

• Excellent verbal and written communication abilities.

• Flexibility, creativity, and empathy to manage priorities and maintain relationships.

• Demonstrated capability to lead during organizational changes.

• Ability to adapt to unclear or changing requirements.

• Proactive problem-solving skills and a strong sense of initiative.

• Strong teamwork skills and a positive attitude.

• Active involvement in team activities and a commitment to fostering a supportive, inclusive work environment.

• Capacity to sit, stand, bend, talk, and hear; frequently walk; and lift or move objects weighing up to 25 pounds.

🏝️ Benefits

• Medical, dental, vision, AD&D, short- and long-term disability, and life insurance.

• 401k retirement savings plan with employer matching.

• Paid parental leave.

• Paid time off.

• Holiday pay.

• Employee Assistance Program.

• Weekly team check-ins.

• Opportunities for professional development.

• Potential for bonuses.