Support healthcare revenue cycle operations by reviewing claim edits, validating coding accuracy, and ensuring appropriate charge capture and billing practices.
This role focuses on researching and resolving coding discrepancies, applying appropriate modifiers, and working assigned claim edits to support timely and accurate reimbursement. The ideal candidate has hospital revenue cycle experience, a strong understanding of medical coding guidelines, and the ability to meet daily productivity and quality expectations.
Responsibilities
- Review and resolve revenue integrity claim edits, coding discrepancies, and billing issues to support accurate and timely claim submission.
- Process a minimum of 175 accounts or claim edits per day while maintaining a quality and accuracy score of at least 95%.
- Apply appropriate CPT modifiers, including Modifier 25 for separately identifiable evaluation and management services and Modifier 50 for bilateral procedures, when supported by coding guidelines and documentation.
- Review claims containing duplicate CPT codes with LT and RT modifiers and determine when appropriate modifier corrections are necessary.
- Identify coding errors, charge omissions, and billing discrepancies, coordinating with appropriate departments to facilitate corrections.
- Review code pair edits and apply appropriate modifier exceptions in accordance with National Correct Coding Initiative (NCCI) guidelines, avoiding inappropriate unbundling of services.
- Research and troubleshoot accounts held in billing work queues due to coding, charging, or documentation discrepancies.
- Monitor late charges and recurring billing issues, identify root causes, and assist with tracking trends and opportunities for improvement.
- Maintain accurate issue logs documenting findings, corrective actions, and resolution progress.
- Assist with the review and maintenance of chargemaster information, charge documents, and charge capture processes.
- Prepare reports on claim edits, coding accuracy, late charges, and other revenue cycle performance metrics.
- Collaborate with revenue cycle, clinical, and IT teams to resolve routine system issues and support process improvements.
- Assist with maintaining system support tickets and escalating complex issues to the appropriate teams.
Requirements & Qualifications
Qualifications
- Active coding certification required, such as Certified Professional Coder (CPC) or an equivalent recognized coding credential.
- Experience in medical coding, claims editing, or healthcare revenue cycle operations.
- Working knowledge of CPT coding, modifier application, and claim edit resolution.
- Understanding of Modifier 25 and the appropriate use of Modifiers 50, LT, and RT.
- Familiarity with NCCI edits, code pair restrictions, and appropriate modifier exceptions.
- Ability to meet daily productivity expectations of at least 175 accounts or claim edits while maintaining a minimum 95% quality and accuracy score.
- Strong attention to detail, analytical skills, and the ability to research and resolve coding discrepancies.
- Proficiency in Microsoft Office, particularly Excel, Outlook, Word, and Teams.
Location
California, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 week ago