Revenue Integrity Coding Specialist

About the Role

Under general supervision, this position reviews and resolves National Correct Coding Initiative (NCCI), Outpatient Claim Editor (OCE), and Medically Unlikely Edits (MUE) related to facility charge capture and coding to ensure appropriate reimbursement, research, and compliance with federal and state regulations. Work adheres to established ICD-10 diagnosis coding and CPT-4 procedure coding classification systems.

Responsibilities

• Review and resolve charge capture, coding, and revenue integrity check workqueues in Epic.
• Serve as a clinical coding subject matter expert, analyzing and evaluating documentation issues with consultation from medical, clinical staff, and clinical documentation specialists as needed.
• Communicate with various hospital departments regarding billing and charge capture issues.
• Refer problems to management in a timely manner with clear details.
• Make independent decisions regarding charge adjustments and other charge resolution techniques.
• Advise management of potential billing problems.
• Ensure all tasks are completed in a timely manner with accurate documentation.
• Apply knowledge of CPT, HCPCS, and revenue codes to ensure accuracy and compliance with all state and federal guidelines.

Requirements

• AAPC or AHIMA certification is required.
• Minimum of two years of experience working with hospital coding-related edits.
• EPIC EMR experience is preferred.
• Associate’s or Bachelor’s degree is preferred.

Skills

• Concern for quality and ability to identify errors and implement corrections.
• Ability to interpret and implement regulatory standards.
• Serves as a resource to others in resolving problems and issues.
• Effective customer service skills, with the ability to work with all levels within the organization.
• Excellent organization skills; demonstrates confidence and creativity.
• Strong time management skills and keen attention to detail.
• Effective verbal and written communication skills for interacting with healthcare and finance professionals, including senior management.
• Good interpersonal relationship skills.
• Self-motivated, detail-oriented, and a problem solver.
• Knowledge and ability to learn and understand HSCRC/CMS regulations, CPT, and ICD-10 coding.
• Proficiency with MS Excel, MS Word, and PowerPoint is required; MS Access, SAS, and Tableau is preferred.
• Ability to handle confidential issues with integrity and discretion.
• Ability to prioritize and manage work in a stressful environment.