Revenue Integrity Coding Specialist

At LifeStance Health, we strive to help individuals, families, and communities with their mental health needs. Everywhere. Every day. It’s a lofty goal; we know. But we make it happen with the best team in mental healthcare.

About the Role

We are seeking a certified Revenue Integrity Coding Specialist to join our Shared Services team, supporting Revenue Cycle Management (RCM) and driving financial performance. The ideal candidate will have a strong working knowledge of CPT rules, ICD-10 guidelines, and payor reimbursement policies. This role involves practice pattern monitoring, claim scrubbing, and payor audit management. The Revenue Integrity Coding Specialist will support revenue cycle with post-payment audits, pre-payment reviews, and claim-line rebuttals to dispute recoupment. Emphasis is placed on preventative process measures for denial prevention, including claim scrubbing, detecting error trends, and working with stakeholders to solve root causes.

We are a collaborative and supportive team with weekly touchpoints and professional development opportunities. Our data-driven approach makes us a great match for Revenue Integrity Coding Specialists interested in data analysis. This role reports to the Sr. Manager, Revenue Integrity. This mission-driven role is crucial in ensuring access to quality mental health care by removing barriers for patients utilizing their healthcare benefits. By managing and executing non-clinical functions, this position allows clinicians to focus on providing exceptional patient care.

This position is a remote role with the ability to sit within any US locality.

Responsibilities

• Accelerate Revenue Cycle Management Business Objectives:
  • Support high-value projects to move the business forward with its strategic goals.
  • Improve Days Sales Outstanding (DSO) and Denial Rate through prompt troubleshooting.
  • Respond to external charge code audits and improve payor audit resolution rates.
  • Problem solve correctable coding errors reducing denials and revenue leakage.
  • Research payer reimbursement guidelines and evaluate impact to coding practices.
• Leverage Intelligent Technology and Data Analysis:
  • Leverage an advanced machine learning tool for proactive detection of trends monitored by health plans.
  • Identify exceptions and outliers, validate the machine learning output with manual review.
  • Use PowerBI and Advanced Excel to identify and confirm trends.
  • Notify state Medical and Clinical Leaders of opportunities to support documentation improvement for payer audits.
  • Evaluate data and partner with Revenue Cycle Leader to enhance upstream intervention and downstream response to coding related denials and exclusions.
• Payer Audits:
  • Execute the Coding Informatics Payer Audit Standardization initiative.
  • Liaise between internal departments and external vendors to align on standard operating procedures for successful medical records submission.
  • Monitor trends in payer audits to enhance workflows and processes.
  • Maintain clear and accurate departmental documents and procedures.
  • Track and monitor the success of various payer audits.
  • Track company performance on payer audits and recoupments.
• Operational Excellence:
  • Provide monthly scorecards to the Sr Director and communicate progress toward personal performance objectives.
  • Execute strategies to improve efficiency, customer satisfaction, and operational effectiveness.
  • Identify inefficiencies in workflows and implement solutions to enhance productivity, quality, and operational efficiency.

Requirements

• Passed a Medical Coding Certificate Exam (CPC, CPC-A, CCS, CPMA) or at least 4 years' experience coaching clinical coding and applying clinical coding in a healthcare setting, demonstrating a proficiency in medical terminology.
• Advanced knowledge of Payor Audits, Rebuttals, and Redeterminations.
• Medical Coding Certificate (CPC, CPC-A, CCS) preferred. Comparable certification and/or degree may be considered in lieu of Medical Coding Certification.
• Advanced Microsoft Excel, with heavy use of data analysis and proficiency in Microsoft Word.
• Experience with Electronic Medical Records, Practice Management Software, and HIPAA requirements.
• Knowledge of mental/behavioral health is desired.
• Strong verbal and written communication skills are important.
• Flexibility, creativity, and empathy to balance priorities and maintain good relationships within the team and with stakeholders.
• Proven ability to lead through organizational change.

Preferred Skills

• Adaptability: Ability to navigate and thrive in situations with unclear or evolving requirements.
• Bias for Action: Proactive approach to problem-solving and willingness to take initiative.
• Team Player: Strong collaboration skills and a positive attitude towards working with team members.
• Engagement: Active participation in team activities and a commitment to contributing to a supportive and inclusive work environment.

Benefits

As a full-time employee of LifeStance Health, the following benefits are offered: medical, dental, vision, AD&D, short and long-term disability, and life insurance. Additional benefits include a 401k retirement savings with employer match, paid parental leave, paid time off, holiday pay, and an Employee Assistance Program.

Pay

$27.50 - $33.00 hourly with potential bonus.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit, stand, bend, talk, and hear. The employee is frequently required to walk.
• The employee must be able to lift and/or move objects up to 25 pounds.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.