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Revenue Integrity Specialist
Confirmed live in the last 24 hours
Albuquerque, NM, USA
Experience Level
  • 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
  • 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
  • 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

501-1,000 employees

Primary care physician platform