Essential Functions and Responsibilities Review and audit claims, medical records, and documentation to identify errors, discrepancies, or compliance issues.
Verify that services provided are correctly documented, coded, and billed according to payer and regulatory requirements.
Work to maximize revenue by identifying opportunities for additional billable services, coding accuracy, and reducing claim denials.
Analyze reimbursement rates and fee schedules to ensure the organization is being reimbursed appropriately.
Provide training and education to clinical and administrative staff on coding and documentation best practices.
Stay updated on changes in coding and billing guidelines and share this information with relevant staff.
Monitor compliance with healthcare regulations, including CMS (Centers for Medicare & Medicaid Services) and third-party payer requirements.
Ensure that all billing and coding practices align with regulatory standards.
Analyze data and prepare reports on key performance indicators related to revenue integrity, such as coding accuracy, claim denial rates, and reimbursement trends.
Identify and implement process improvements to enhance revenue integrity, streamline workflows, and reduce errors.
Collaborate with relevant departments to resolve issues and enhance revenue cycle processes.
Assist coders and clinical staff with complex coding scenarios and documentation requirements.
Conduct regular chart reviews and provide feedback to improve documentation quality.
Requirements:
Bachelor's degree in a related field, such as healthcare administration, health information management, or nursing. Relevant certifications (e.g., Certified Professional Coder - CPC) may be preferred.
Several years of experience in healthcare billing, coding, or revenue cycle management, with a focus on revenue integrity.
