Revenue Cycle Liaison | BAR - BCBS

Responsibilities

• Review and analyze physician coding and billing practices to ensure compliance with ICD-10, CPT, payer, and organizational guidelines.
• Investigate and resolve complex claim denials, underpayments, and reimbursement variances.
• Conduct detailed data analysis to identify denial trends, coding opportunities, and revenue cycle improvement initiatives.
• Interpret managed care contracts and payer policies to support accurate reimbursement and appeals strategies.
• Develop and submit comprehensive appeals, including coding rationale, clinical documentation, supporting literature, and payer-specific references.
• Collaborate with providers, coding teams, billing staff, compliance, and operational leaders to address reimbursement and coding concerns.
• Monitor and report on denial trends, reimbursement performance, and revenue cycle metrics.
• Recommend process improvements to enhance coding accuracy, reduce denials, and improve financial outcomes.
• Provide education and guidance regarding coding, documentation, billing requirements, and payer regulations.
• Serve as a liaison between clinical, coding, billing, and payer stakeholders to facilitate issue resolution and revenue recovery.

Qualifications

• High school diploma or equivalent required.
• Associate degree in Healthcare Administration, Business, Health Information Management, or a related field preferred.
• Two (2) years of experience in hospital and/or physician billing required.
• Experience with healthcare revenue cycle processes, billing regulations, and reimbursement practices preferred.
• Experience working with claim denials, appeals, reimbursement analysis, and payer guidelines preferred.
• Experience using the Epic electronic health record (EHR) system preferred.

Knowledge, Skills, And Abilities

• Knowledge of ICD-10, CPT, and healthcare billing and reimbursement practices preferred.
• Ability to code both diagnoses and procedures preferred.
• Ability to interpret payer policies, managed care contracts, and reimbursement methodologies.
• Comfortable communicating with physicians, providers, and payers regarding diagnosis and procedure relationships, billing requirements, reimbursement variances, and coding concerns.
• Ability to confidently and professionally advocate for coding and billing reviews, corrections, and process improvements.
• Strong analytical, research, problem-solving, and organizational skills.
• Proficiency with Microsoft Excel and healthcare-related software applications, such as EncoderPro or similar coding and reimbursement tools.