What you will be doing:

• Analyze various data sources to identify discrepancies between payer data and what was reported on the outbound 837 claims file
• Report on trends, findings, and opportunities for improvement detailing findings and high risk items that leaders should be monitoring
• Reviews billing workflows and works with the appropriate teams to adjust billing systems to better catch errors and/or omissions
• Assist with finding root cause reasons and propose solutions for issues leading to revenue leakage and/or reduced reimbursement;
• Contribute to the design and implementation of a 837 claims data-monitoring tool to help pinpoint potential revenue leakage
• Consistently track findings and follow-up actions in accordance with the standardized tracking tool to ensure results are accurately communicated
• Perform other duties and special projects assigned 

Required Skills & Experience:

• 3+ years of experience in billing and coding of clinical services in ambulatory care
• Strong understanding of documentation, billing, and coding workflows and best practices as it relates to risk adjustment and diagnosis documentation.
• Thorough understanding of medical coding guidelines and regulations including compliance, reimbursement, and the impact of diagnosis documentation on risk adjustment payment models.
• Knowledgeable in the use and application of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Revenue codes.
• Skills in a common database, spreadsheet, and presentation software.

Preferred Certifications, Skills, & Experience:

• Current certification as a Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Revenue Cycle Representative (CRCR) or equivalent.
• Experience optimizing practice EHR workflows.
• Results-oriented with the ability to meet financial and operational targets.
• Proven track record of communicating effectively with senior management.