Revenue Cycle and Coding Specialist

Our take on this role

About this role

Review clinical documentation and assign codes to support billing, reimbursement, and revenue cycle processes. This is a remote position; occasional travel to the office may be required.

What could you bring from clinical work?

• Nurses, PTs and SLPs: Reviewing clinical records for medical necessity could help you identify documentation gaps and opportunities for improvement.
• OTs: Your experience documenting functional limitations and treatment services may help with reviewing documentation to assign appropriate codes and modifiers.
• Social workers: Documenting behavioral health services and medical necessity could help you review clinical records for documentation improvements.

Full job description from FAMILY RESOURCE CENTER OF NORTHWEST OHIO INC

We are seeking a detail-oriented Revenue Cycle and Coding Specialist to support accurate, complete, and compliant clinical documentation, coding, billing, reimbursement, and revenue cycle processes. The ideal candidate will have experience in clinical documentation improvement, clinical coding, billing, health information management, and revenue cycle operations. Remote position with occasional travel to the office may be required. Experience in FQHC and behavioral health settings is preferred.

Qualifications include active coding certificate, associates degree in related education or experience in health information management, medical coding, billing, or a clinical profession; a recognized coding, clinical, or health information credential; strong knowledge of ICD-10-CM/PCS, CPT, HCPCS, payer guidelines, reimbursement, medical necessity, medical terminology, anatomy, physiology, clinical documentation, records management, billing terminology, and healthcare compliance. The role also requires the ability to analyze and present complex information clearly, proficiency with Microsoft Office, Excel, Teams, internet resources, EHR and practice management systems, encoders, clearinghouses, and billing software, along with professional, service-oriented communication and strong attention to detail.

Responsibilities Include:

• Analyze clinical documentation to identify opportunities for improvement.
• Provide or coordinate education
• Partner with departments, clinical and revenue cycle teams
• Participate and complete audits
• Analyze and react to data
• Maintain and possess working knowledge of multiple payer types
• Ability to maintain confidentiality of patient information and comply with HIPAA and organizational privacy policies.

• Review and ensure accurate data is documented
• Assign appropriate ICD-10-CM, CPT, HCPCS, and modifiers, based on documentation and applicable coding guidelines.
• Prepare, review, submit, and track clean claims for all payer plans
• Prepare, review, submit, and track prior authorizations
• Process reimbursements and payments
• Monitor accounts receivable
• Perform other job-related duties as assigned.