The Revenue Integrity and Coding department's main focus is to improve coding and charge capture to reduce the risk of non-compliance, optimize payment and minimize the expense of correcting errors within the revenue cycle. Link together revenue cycle operations with clinical operations. The department adheres to strict coding standards and guidelines set forth by governing parties. Prevent recurrence of issues that can cause revenue leakage and/or compliance risks through effective, efficient, replicable processes and internal controls. Promote activities to ensure that clean complete claims are submitted, that revenue capture is correct and compliant. The department is responsible for several core functions including:

  • Chargemaster Description Maintenance
  • Charge reconciliation
  • Professional Revenue and CPT Coding
  • Working claims edit, rejection, and denial work queues
  • Participate in provider coding audits
  • Manage provider education and training
  • Responsible for researching root causes for preventable denials and creates and follows through with action plans to decrease denials

Reports To:

  • VP, Population Health and Clinic Operations,
  • VP, Network Development and Home Health

Job Duties:

  • Responsible for periodic training workshops to promote awareness of governance, risk management, and internal controls direct programs, policies, and practices to ensure that all business units are in compliance with financial policy and reporting regulations
  • Maintains knowledge of current technical and professional coding certification requirements and promotes recruitment and retention of certified staff in coding positions
  • Conducts meetings with providers to review coding and documentation issues, and educate on governmental and managed care specific requirements
  • Requires a working level of knowledge of medical, ICD9CM, ICD10, CPT, and HCPCS coding terminology and documentation standards and guidelines
  • Maintains a close working relationship with Physicians and clinic staff.
  • Supports clinics to ensure accuracy consistent with industry standards with compliance and corporate coding guidelines.
  • Conducts meetings with providers to review coding and documentation issues, and educate on governmental and managed care specific requirements
  • Maintains knowledge of current technical and professional coding certification requirements and promotes recruitment and retention of certified staff in coding positions
  • Responsible for researching root causes for preventable denials and creates and follows through with action plans to decrease denials
  • Creates and oversees benchmarks for coding and coding staff
  • Establishing and maintaining effective working relationships with all levels of management and physicians.

Qualifications:

  • Bachelor’s degree in Business Administration or Healthcare Administration preferred
  • Prior experience with physician EMRS, EClinical Works preferred.
  • Possess a minimum of (5) five years progressive revenue cycle management experience with multi-specialty expertise, application in a variety of practice models and sites of service.
  • Prior experience leading and managing a moderate size staff in a healthcare environment from the entry and supervisor level.
  • Requires a working level of knowledge of medical, ICD9CM, ICD10, CPT, and HCPCS coding terminology and documentation standards and guidelines.
  • Working knowledge of a broad range of Part A and Part B services is preferred (excluding hospital-based).