Revenue Integrity Coding Analyst

Overview

Unified Women’s Healthcare is a company dedicated to caring for OB/GYN providers who care for others, be the physicians or their support staff. A team of like-minded professionals with significant business and healthcare experience, we operate with a singular mindset - great care needs great care. We take great pride in not just speaking about this, but executing on it.

As a company, our mission is to be an indispensable source of business knowledge, innovation and support to the practices in our network. We are advocates for our OB/GYN medical affiliates - enabling them to focus solely on the practice of medicine while we focus on the business of medicine.

We are action oriented. We strategize, implement and execute - on behalf of the practices we serve.

The Revenue Integrity Coding Analyst is entrusted with the job of reviewing, auditing and coding provider’s documentation for the purpose of reimbursement, training, education and compliance using ICD-10 and CPT codes. The successful applicant will serve as an information resource and guide to our providers, clinical staff, practice managers, members of the Revenue Cycle team and other leadership. This position will be directly involved in analyzing pre-bill claim edits, claim denials and Accounts receivable (AR) management, and working alongside the Revenue Specialists, will review and amend denied claims to ensure accurate coding and adherence to payor policy requirements. The Revenue Integrity Coding Analyst will assist the Revenue Cycle Manager in proactive audits of medical charts and records for compliance with federal coding regulations and guidelines. This role utilizes knowledge of client systems and procedures to provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. The Revenue Integrity Coding Analyst reviews, develops, and/or modifies client procedures, systems, and protocols to achieve and maintain compatibility with billing requirements and compliance standards.

Responsibilities

• Provide second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices
• Audit medical record documentation to identify under-coded and/or up-coded services; prepare reports of findings and meet with providers to provide education and training on accurate coding practices and compliance issues
• Interact with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtain clarification of conflicting, ambiguous, or non-specific documentation through provider queries
• Interact with internal and external Revenue Specialists and practice billing teams to ensure appropriate and complete follow-up of patient accounts to maximize reimbursement
• Complete AR follow up processes, including claim corrections, appeals, payor follow up and resubmissions to expedite reimbursement relation to coding or other payor based denials
• Analyze individual payor performances regarding fee schedule reimbursements and trends
• Research, analyze, and respond to inquiries regarding compliance, payor policies and guidelines, inappropriate coding, denials, and billable services
• Monitor and distribute communications regarding payor policy changes and updates, in relation to our provider specialties
• Serve as an information resource and guide to clinicians, champion the need to change coding behaviors and serve as subject matter expert and correct documentation as needed
• Complete and coordinate with internal and external billing teams to create and test claim edits and scrubs to allow for accurate coding to help expediate reimbursement
• Train, instruct, and provide support to medical providers and practice billing specialists as appropriate regarding coding compliance, documentation, and regulatory provisions, and third-party payor requirements
• Review, develop, modify, and adapt relevant client procedures, protocols, and data management systems to ensure compliance with organization’s policies
• Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, coding, claims, and state insurance laws
• Ensure strict confidentiality of financial and medical records
• Perform miscellaneous job-related duties as assigned to impact revenue or drive efficiencies
  
  

Qualifications

• Certified Professional Coder (CPC) or Certified Obstetrics Gynecology Coder (COBGC) certification required
• E/M Coding experience required
• Minimum of 3 years’ experience as a biller, collector, coder, or back office support staff, or other equivalent medical industry experience
• OB/GYN experience preferred, but not required
• Associates degree from an accredited university preferred
• Athena experience preferred, but not required
• Knowledge of auditing concepts and principles
• Advanced knowledge of medical coding and billing systems and regulatory requirements
• Ability to use independent judgment and to manage and impart confidential information
• Ability to analyze and solve problems
• Ability to travel (up to 25%, as needed)
• Strong communication, presentation and interpersonal skills
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation
• Knowledge of current and developing issues and trends in medical coding procedures requirements
• Ability to clearly communicate medical information to professional practitioners and/or the general public
• Detailed knowledge of medical coding systems, procedures, and documentation requirementsAbility to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirementsAbility to provide guidance and training to professional and technical staff in area of expertise.
  
  

We offer a competitive salary and an excellent benefit package that includes health/dental/life/STD/LTD/vision insurance, paid time off, and 401(k) plan. This company is a drug-free workplace and an Equal Employment Opportunity employer.

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