Revenue Integrity Coding Analyst

Unified Women's Healthcare

Full-time - Mid Level

Ambulatory Health Care Services

About the position

The Revenue Integrity Coding Analyst at Unified Women's Healthcare plays a crucial role in ensuring accurate coding and compliance for OB/GYN providers. This position involves reviewing, auditing, and coding medical documentation to facilitate reimbursement and maintain adherence to federal coding regulations. The analyst serves as a resource for providers and staff, analyzing claims, managing accounts receivable, and providing education on coding practices.

Responsibilities

• Provide second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements.
• Audit medical record documentation to identify under-coded and/or up-coded services; prepare reports of findings and meet with providers to provide education and training on accurate coding practices and compliance issues.
• Interact with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtain clarification of conflicting, ambiguous, or non-specific documentation through provider queries.
• Interact with internal and external Revenue Specialists and practice billing teams to ensure appropriate and complete follow-up of patient accounts to maximize reimbursement.
• Complete AR follow up processes, including claim corrections, appeals, payor follow up and resubmissions to expedite reimbursement related to coding or other payor based denials.
• Analyze individual payor performances regarding fee schedule reimbursements and trends.
• Research, analyze, and respond to inquiries regarding compliance, payor policies and guidelines, inappropriate coding, denials, and billable services.
• Monitor and distribute communications regarding payor policy changes and updates, in relation to our provider specialties.
• Serve as an information resource and guide to clinicians, champion the need to change coding behaviors and serve as subject matter expert and correct documentation as needed.
• Complete and coordinate with internal and external billing teams to create and test claim edits and scrubs to allow for accurate coding to help expedite reimbursement.
• Train, instruct, and provide support to medical providers and practice billing specialists regarding coding compliance, documentation, and regulatory provisions, and third-party payor requirements.
• Review, develop, modify, and adapt relevant client procedures, protocols, and data management systems to ensure compliance with organization's policies.
• Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, coding, claims, and state insurance laws.
• Ensure strict confidentiality of financial and medical records.

Requirements

• Certified Professional Coder (CPC) or Certified Obstetrics Gynecology Coder (COBGC) certification required.
• E/M Coding experience required.
• Minimum of 3 years' experience as a biller, collector, coder, or back office support staff, or other equivalent medical industry experience.
• Associates degree from an accredited university preferred.
• Knowledge of auditing concepts and principles.
• Advanced knowledge of medical coding and billing systems and regulatory requirements.
• Ability to use independent judgment and to manage and impart confidential information.
• Strong communication, presentation and interpersonal skills.
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.

Nice-to-haves

• OB/GYN experience preferred, but not required.
• Athena experience preferred, but not required.

Benefits

• Disability insurance
• Dental insurance
• 401(k)
• Paid time off
• Vision insurance