Consultant - Revenue Integrity

Job description

Opportunity for a team player who understands medical terminology, coding, charge entry, insurance adjudication and collections. Must be organized and preferably possess CPC certification and/or other coding credentials/clinical expertise. The ideal candidate can work independently in a home office setting, is a problem-solver, taking on challenges independently with a strong attention to detail, who enjoys working in a collaborative and team-based environment. 

Responsibilities

  • Conduct ongoing retrospective documentation, coding and billing reviews to identify opportunities for revenue capture as well as potential compliance risks. 
  • Apply knowledge of Official Coding Guidelines for ICD-10-CM and ICD-10-PCS, Coding Clinic and CPT Assistant to various coding situations. 
  • Assist with governmental or third-party payer denials by evaluating compliance with coding guidelines, LCD’s, NCD’s and any applicable CMS or managed care payer guidelines. 
  • Evaluate claim edits for coding and billing deficiencies, reprocessing when necessary. 
  • Prepare accurate and thorough work papers, with complete documentation to support findings. 

Qualifications

  • Bachelor’s degree preferred. 
  • Minimum of 5+ years of auditing/coding experience with CPT, ICD-10, HCPCS and Modifier Coding. 
  • Knowledge of anatomy, physiology and medical terminology commensurate with the ability to correctly code various types of services and diagnoses. 
  • Working knowledge of billing guidelines, payer reimbursement policies, medical necessity criteria, and applicable industry based standards. 
  • Certified Procedural Coder (CPC) or Certified Outpatient Coding (COC), formerly CPC-H by the American Academy of Procedural Coders, or Certified Coding Specialist (CCS), or Certified Coding Associate (CCA) by the American Health Information Management Association (AHIMA) 
  • Proficient in Microsoft Office Suite including Word, Excel and e-mail application. 
  • Ability to communicate effectively with managers, clients and team members. 
  • Demonstrates independent judgment, discretion, and decision-making abilities.

 

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