Responsible for analyzing patient clinical and billing data to identify documentation, coding, and denial prevention opportunities. This role supports revenue cycle operational efficiency, data integrity, and compliance with billing and regulatory guidelines.
The position is split between operations and front-end eligibility/denials support. It performs root cause analysis, develops denial prevention action plans, conducts audits, collaborates with clinical and revenue cycle teams, and supports denial coordination and appeals. The role also helps maintain charge accuracy, resolve complex denials, and improve revenue cycle processes.
May require travel between locations within the region.
Bachelor's degree in Healthcare, Business Administration, Finance, Accounting, Nursing, or a related field, or equivalent education and experience.
At least 5 years of experience in billing, charge documentation, charge audit, charge capture, or related revenue cycle functions.
Demonstrated knowledge of:
- Clinical processes
- Charge master maintenance
- Clinical coding, including CPT, HCPCS, ICD-9/10, revenue codes, and modifiers
- Charging processes and audits
- Clinical billing
- Third-party payer rules and requirements
- APC and OPPS reimbursement structures
- Outpatient coding edits, CCI edits, and DNFB
- Post-payment audits and coding/technical denials
Preferred credentials include RHIA, RHIT, CCS, CPC/COC, or similar coding certification. CDC compliance certification preferred.
Strong skills in Excel, Access, Business Objects, Word, and PowerPoint are desired. Excellent analytical, organizational, communication, and time management skills are required.
Location
New York, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
3 weeks ago