Revenue Integrity Coder

Responsibilities

• Optimization of charge capture, charge review, appropriate documentation and work queue edits for all infusion services, specifically Oncology and Chemotherapy.
• Serves as the primary contact/resource for Patient Financial Services, Revenue Integrity and Infusion Clinical Staff.
• Participates in external and internal audits, quality improvement initiatives, and assists with special projects.
• Works closely with Catholic Health fiscal teams, Clinical Center Leadership, and Prior Authorization teams.
• Identifies trends, monitors insurer policy changes, and educates clinical and revenue cycle teams on appropriate CPT, HCPCS, and modifier usage.
• Takes ownership of infusion-related denials, performs detailed account reviews, and drives process improvements to enhance revenue integrity and reduce financial risk.
• Supports appeals processing for various health system teams or programs.
• Provides support for reimbursement, financial analysis, denial trends, charges, and report generation within revenue cycle.

Qualifications

• Associate degree required - Health Information Management, Healthcare Administration, or related field preferred
• Bachelor's Degree preferred
• One of the following certifications is required: CPC (Certified Professional Coder), CCS (Certified Coding Specialist), RHIT or RHIA preferred
• Minimum of 3-5 years of coding or revenue integrity experience, with a focus on oncology, chemotherapy, and infusion services
• Experience with hospital or outpatient infusion coding is strongly preferred
• Experience working in revenue integrity or audit-focused role preferred
• Experience dealing with health insurance, prior authorizations and claims resolution desirable
• Experience with documentation and documentation issue resolution desirable
• Deep understanding of CPT, HCPCS, ICD-10-CM, and modifier usage for infusion and oncology services
• Strong knowledge of payer policies and reimbursement methodologies
• Strong communication, interpersonal, organizational, and computer skills
• Proficient in gathering, analyzing and interpreting data, and working both independently and as part of a team to solve problems, make and implement recommendations
• Proficient with computers, software applications, and report generation
• Ability to work cross-functionally and influence process improvements
• High Tolerance for ambiguity and uncertainty
• Detail oriented and quality driven, with a focus on accuracy and compliance
• Excellent communication skills with the ability to educate clinical and non-clinical staff
• Strong analytical and problem-solving abilities
• Proficient in EPIC