Responsible for performing in-depth analysis of patient clinical and billing data to identify documentation, coding, and denial prevention opportunities. Develops and implements action plans based on root cause analysis findings to improve revenue cycle efficiency, data integrity, and compliance with billing and regulatory guidelines.
Works closely with clinical departments, Patient Business Service (PBS), Payer Strategies, Compliance, and other revenue cycle teams to support denial coordination, denial prevention, pre-bill edit prevention, audits, and charge capture improvement. Coordinates appeals and reconsideration requests for clinical, coding, and technical denials, and maintains denial and appeals logs in accordance with established guidelines.
May travel between regional locations as needed.
Qualifications
- Bachelor's degree in Healthcare, Business Administration, Finance, Accounting, Nursing, or a related field, or an equivalent combination of education and experience
- 5+ years of experience in billing, charge documentation, charge audit, charge capture, or related revenue cycle functions
- Strong knowledge of clinical processes, charge master maintenance, clinical coding (CPT, HCPCS, ICD-9/10, revenue codes, and modifiers), charging processes, audits, and clinical billing
- Working knowledge of third-party payer rules and requirements, computer operations, and electronic interfaces related to charge documentation, capture, and billing
- Experience with post-payment audits and coding, clinical, and technical denials
- Proficiency with MS Excel; Access and Business Objects strongly desired
- Strong organizational, analytical, communication, and time management skills
- Ability to manage multiple priorities in a fast-paced, collaborative environment
- Preferred credentials: RHIA, RHIT, CCS, CPC/COC, or other coding certifications; CDC compliance certification preferred
Location
New York, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
3 weeks ago