Key Facts

Remote From:

Full time

English

Hard Skills

Medical Billing Medical Coding Revenue Management Claims And Litigation Management Cross-Functional Collaboration Process Optimization Revenue Management Medical Record Management Process Improvement Analytics Reimbursement Regulations Documentation Based Coding Claims And Litigation Management Clinical Documentation KPI Reporting Employee Coaching

Other Skills

•
Communication
•
Analytical Thinking
•
Detail Oriented
•
Problem Solving

Roles & Responsibilities

Bachelor's degree in healthcare administration, health information management, nursing, or a related field
Certification such as CPC (Certified Professional Coder) or equivalent
Several years of experience in healthcare billing, coding, or revenue cycle management, with a focus on revenue integrity
Experience with auditing claims for compliance and ability to analyze reimbursement trends

Requirements:

Review and audit claims, medical records, and documentation to identify errors and ensure correct documentation, coding, and billing per payer and regulatory requirements
Maximize revenue by identifying opportunities for additional billable services, improving coding accuracy, and reducing claim denials
Provide training and education to clinical and administrative staff on coding and documentation best practices, and stay updated on changes in guidelines
Monitor compliance with healthcare regulations (e.g., CMS and payer requirements), analyze data, prepare KPI reports (coding accuracy, denial rates, reimbursement trends), and drive revenue integrity process improvements

Job description

Job Type

Full-time

Description

Position Summary

The Revenue Cycle Specialist is responsible for optimizing revenue and ensuring the accuracy and compliance of all billing and coding practices within a healthcare organization. This role involves analyzing and auditing claims, providing education and training to staff, and implementing processes to enhance revenue integrity.

Essential Functions and Responsibilities

Review and audit claims, medical records, and documentation to identify errors, discrepancies, or compliance issues.
Verify that services provided are correctly documented, coded, and billed according to payer and regulatory requirements.
Work to maximize revenue by identifying opportunities for additional billable services, coding accuracy, and reducing claim denials.
Analyze reimbursement rates and fee schedules to ensure the organization is being reimbursed appropriately.
Provide training and education to clinical and administrative staff on coding and documentation best practices.
Stay updated on changes in coding and billing guidelines and share this information with relevant staff.
Monitor compliance with healthcare regulations, including CMS (Centers for Medicare & Medicaid Services) and third-party payer requirements.
Ensure that all billing and coding practices align with regulatory standards.
Analyze data and prepare reports on key performance indicators related to revenue integrity, such as coding accuracy, claim denial rates, and reimbursement trends.
Identify and implement process improvements to enhance revenue integrity, streamline workflows, and reduce errors.
Collaborate with relevant departments to resolve issues and enhance revenue cycle processes.
Assist coders and clinical staff with complex coding scenarios and documentation requirements.
Conduct regular chart reviews and provide feedback to improve documentation quality.

Requirements

Bachelor's degree in a related field, such as healthcare administration, health information management, or nursing. Relevant certifications (e.g., Certified Professional Coder - CPC) may be preferred.
Several years of experience in healthcare billing, coding, or revenue cycle management, with a focus on revenue integrity.

Ready to apply?

APPLY

Share ·