Revenue Integrity Medical Coder

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​​​​​​​Responsibilities:

• Coding for Revenue Accuracy
  • Review clinical documentation to accurately assign ICD-10-CM, CPT, and HCPCS Level II codes, with a specific focus on ensuring codes support medical necessity, charge capture, and compliance billing practices.
  • Apply modifiers correctly to ensure appropriate reimbursement and prevent denials.
  • Ensure coding complies with Official Coding Guidelines, payer regulations (including TRICARE), NCCI edits, and DoD/DHA policies impacting revenue.
• Revenue Cycle & Work Queue Management
  • Proactively utilize MHS GENESIS (Cerner Millennium) to review documentation, assign codes, and investigate coding-related revenue issues.
  • Actively monitor, prioritize, research, and resolve coding and billing-related edits found in electronic work queues (e.g. claim edits, charge review queues, pre-bill holds, coding validation queues, and denials management queues).
  • Meet established productivity and quality standards for coding accuracy, work queue resolution timeliness, and financial impact.
• Charge Validation and Reconciliation
  • May assist in validating that charges generated are appropriate and supported by clinical documentation and coding assignments.
  • Identify discrepancies between documented/coded services and captured charges, investigating and recommending corrective actions.
• Compliance and Auditing Support
  • Adhere strictly to HIPAA regulations and maintain patient confidentiality.
  • Stay current with coding updates, payer rules, reimbursement methodologies (DRG, APC, etc.), and federal/local regulations impacting revenue integrity.
• Collaboration and Process Improvement
  • Serve as a subject matter expert on coding guidelines related reimbursement and billing.
  • Provide feedback to client stakeholders regarding documentation improvement opportunities impacting revenue integrity.
  • Identify trends in work queue edits or denials and contribute to process improvement initiative to prevent recurrence.
  • Actively participate within project team(s) and engages with team members to ensure project objectives and client needs are met. Provides support and guidance as needed to ensure quality work products.
  • Adheres to all established project processes, procedures, and guidelines regarding resources and how to use them. Communicates with leadership regarding resource needs and communicates changes.
  • Adheres to defined work plans while maintaining all established timelines and deliverable deadlines.
  • Assists in developing effective internal and external presentations and skillfully helps to facilitate client and internal team meetings.
  • Ability to meet internal and external deadlines by efficiently managing time, prioritizing tasks, and utilizing available resources.
  • Accurately documents client communications and shares information with the project team.
  • Maintains effective communication with client and project team members.

• Certification: Must possess and maintain a valid coding credential from AHIMA (e.g., RHIA, RHIT, CCS, CCS-P) or AAPC (e.g., CPC, COC, CIC, CPC-P).
• Experience: Minimum of 3+ years of recent medical coding experience, with demonstrated experience int asks related to revenue integrity, charge capture review, denial management, and resolving coding-related billing edits.
• EHR Experience: Demonstrated proficiency and hands-on experience using Cerner Millennium. Experience specifically with MHS GENESIS, including navigating coding, charge, and billing-related modules/work queue, is highly desirable.
• Work Queue Management: Proven ability to efficiently manage and resolve revenue cycle work queues, including coding edits, charge review, and pre-billing holds within an EHR system.
• Knowledge:
  • Expert knowledge of ICD-10-CM and CPT/HCPCS coding systems and guidelines.
  • Strong understanding of medical terminology, anatomy & physiology, and disease processes.
  • Strong understanding of healthcare revenue cycle processes, reimbursement methodologies, and payer requirements (especially TRICARE).
  • Familiarity with NCCI edits, LCDs/NCDs, and modifier usage impacting payment.
  • Knowledge of HIPAA, and healthcare compliance regulations related to coding and billing.
• Skills:
  • Exceptional attention to detail and accuracy.
  • Strong analytic, investigative, and problem-solving skills.
  • Proficient computer skills, including EHR navigation and Microsoft Office Suite.
  • Excellent written and verbal communication skills.
  • Ability to work independently, prioritize tasks, and meet deadlines in a production-driven environment.
  • Ability to analyze and interpret complex data, processes, and reports related revenue cycle and integrity.
• Access: 
  • Ideal candidate would have an active security clearance with the DHA.