Revenue Integrity Coding Specialist

Job Requirements

General Summary

Under general supervision this position will review and resolve National Correct Coding Initiative, Outpatient Claim Editor, and Medically Unlikely Edits related to facility charge capture and coding for the purpose of appropriate reimbursement, research and compliance with federal and state regulations according to established ICD-10 diagnosis coding and CPT-4 procedure coding classification systems.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Knowledge of CPT, HCPCS, and revenue codes for accuracy and compliance with all state and federal guidelines.

2. Responsible for reviewing and resolving charge capture, coding, and revenue integrity check workqueues in Epic.

3. Serves as a clinical coding subject matter expert, and utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed.

4. Communicates with various departments within the hospitals regarding billing and charge capture issues. Refers any problems to management timely, providing clear details.

5. Responsible for making independent decisions regarding charge adjustments and other charge resolution techniques.

6. Advises management of possible billing problems.

7. Complete all tasks in a timely manner with accurate documentation.

Work Experience

Education and Experience

1. Associates or Bachelor’s degree is preferred.

2. AAPC or AHIMA certification is required.

3. Two years minimum experience working hospital coding related edits.

4. EPIC EMR experience in preferred.

Knowledge, Skills and Abilities

1. Concern for quality and ability to identify errors and implement corrections.

2. Ability to interpret and implement regulatory standards.

3. Serves as a resource to others in the resolution of problems and issues.

4. Effective customer service skills, with the ability to work with all levels within the organization.

5. Excellent organization skills, demonstrates confidence and creativity.

6. Strong time management skills and keen attention to detail.

7. Effective verbal and written communication skills are necessary in dealing with a variety of healthcare and finance professionals including senior management staff.

8. Good interpersonal relationship skills.

9. Self-motivated, detail oriented, problem solver.

10. Knowledge and ability to learn and understand HSCRC/CMS regulations, CPT (Current Procedural Terminology), and ICD-10 coding.

11. Ability to operate a personal computer is required. Proficiency with the following applications is required: MS Excel, MS Word, and PowerPoint. MS Access, SAS, & Tableau is preferred.

12. Ability to handle confidential issues with integrity and discretion.

13. Ability to prioritize and manage work in a stressful environment.