Consultant - Revenue Integrity

Job description

Opportunity for a team player who understands medical terminology and has experience in the coding, charge entry and CDM environment. Must be organized and preferably possess CPC certification and/or other coding credentials/clinical/revenue cycle expertise. The ideal candidate is a problem-solver, taking on challenges independently with a strong attention to detail, who enjoys working in a collaborative and team-based environment.


  • Conducts prospective and retrospective documentation, coding and billing reviews for the purpose of identifying revenue capture opportunities as well as potential compliance risks, attentive to NCD’s, LCD’s and any applicable CMS or managed care payer guidelines.

  • Applies knowledge of Official Coding Guidelines for ICD-10-CM and ICD-10-PCS, Coding Clinic and CPT Assistant to various coding situations.

  • Conducts reviews to assess the accuracy of CDM for services requiring CPT/HCPCS codes, to include compliance with governmental guidelines and regulations.

  • Evaluates claim edits for coding and billing deficiencies.

  • Prepares accurate and thorough work papers and audit documentation to support findings.

  • Assists with the development of education material for clients on documentation and coding opportunities, to include practitioners, clinical staff, allied health professionals and coders.


  • Associate degree, Bachelor’s degree preferred.

  • Minimum of 5+ years of facility and/or professional 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 provider billing guidelines, payer reimbursement policies and contracts, medical necessity criteria, and applicable industry-based standards.

  • Certified Procedural Coder (CPC) or Certified Outpatient Coding (COC) 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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