Responsible for optimizing revenue and ensuring the accuracy and compliance of billing and coding practices within a healthcare organization.
Key Responsibilities
- Review and audit claims, medical records, and documentation to identify errors, discrepancies, or compliance issues.
- Verify that services are correctly documented, coded, and billed according to payer and regulatory requirements.
- Maximize revenue by identifying opportunities for additional billable services, coding accuracy, and reduced claim denials.
- Analyze reimbursement rates and fee schedules to ensure appropriate reimbursement.
- Provide training and education to clinical and administrative staff on coding and documentation best practices.
- Stay current on coding and billing guideline changes and share updates with relevant staff.
- Monitor compliance with healthcare regulations, including CMS and third-party payer requirements.
- Ensure billing and coding practices align with regulatory standards.
- Analyze data and prepare reports on key revenue integrity metrics, including coding accuracy, 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 improve 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 & Qualifications
Qualifications
- Bachelor's degree in a related field such as healthcare administration, health information management, or nursing.
- Relevant certification such as 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.
- Eyecare experience preferred.
Location
South Carolina, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago