Revenue Integrity Coding Specialist

Luminis Health Clinical Enterprise

Title:  Revenue Integrity Coding Specialist         

Department:  Professional Business Office

Reports To:  VP, Behavioral Health and PBO

Cost Center/Job Code:  41000-50050-002099

FLSA Status:  Non - Exempt

Position Objective:

The Revenue Integrity Coding Specialist works in the Luminis Health Clinical Enterprise Professional Business Office (PBO) and serves as the key liaison and subject matter expert on all aspects of charge capture and entry, charge integrity and charge reconciliation processes. This position will support and coordinate on-going charge capture and integrity improvement initiatives for assigned service line areas; including charge reconciliation activities, new service or practice implementation, third party vendor (coding) audits, and identification of revenue management opportunities. They will align with service line leadership and serve as the subject matter expert regarding accuracy of charge capture and integrity processes including education, audit activities, changes or risk of revenue (regulatory or coding changes) and monitoring of charge capture related metrics to minimize revenue leakage.

Essential Job Duties:

1. Proficient Use of Support Systems

• Efficient utilization of billing system database to update facility file, Charge Description Master (CDM);  ensures broad understanding of all areas of revenue cycle including pre-AR, actualized AR review and router logic
• Ability to appropriately edit charges via Charge Router and document actions via notes in the Resolute billing system.
• Demonstrated ability to utilize Outlook email and navigate in the Word and Excel software applications. Maintains relationship with clearinghouse, including appropriate follow-up with support issues.

1. Competence in Coding and Charge Integrity Workflows

• Evaluates current charging and coding structures in clinical, coding and professional billing departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements
• Assess the accuracy and build of all Charge Capture related workflows in EPIC, including documentation, automation enhancements
• Demonstrates the ability to understand and utilize payer rejections and remittance denials to execute denial management strategies in an effort to mitigate the risk of future denials.

1. Organizational Efficiency

• Effectively maintains audit and account activity by ensuring the proper organization, tracking, filing and documenting of all correspondence. 
• Assists in proactive communication and root cause analysis of challenges impacting final adjudication of claims, including but not limited to system or payer issues

1. Provides Outstanding Customer Service  

• Creates a cross-collaborate approach with services lines, billing teams, Coding, HIM and other key stakeholders to improve charge capture, compliant documentation to substantiate charges, charge reconciliation and compliant billing of all charges.

1. Business Conduct

• Displays professionalism in the workplace maintaining a positive and approachable team attitude; demonstrates dependability through attendance and reliability via non-existent tardiness.

Educational/Job Experience Requirements:

• High school diploma or GED required
• Two to four years of multi-specialty billing experience preferred including ICD10, CPT, medical terminology or related experience.
• Works well in environment with firm deadlines; results oriented
• Demonstrates strong knowledge of end to end revenue cycle
• Experience in EPIC required
• Experience with Microsoft Office, Word and Excel
• Ability to communicate professionally via internet and virtual communication tools

Required License/Certifications: 

• Coding certification required (CPMA, CPC, CBCS or CCS)

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.