What are the responsibilities and job description for the Revenue Cycle Specialist-Revenue Integrity (Remote) position at WCM-Q?
Position Summary
Remote position – Join a team of dedicated revenue cycle professionals in the Central Business Office (CBO) of Weill Cornell Medicine (WCM). Apply your knowledge as a Certified Professional Coder to investigate and resolve coding related insurance payment denials. The CBO partners with WCM Clinical Departments to increase and expedite service revenue, reduce aged AR, and trend denials for their root causes thereby driving efficiencies, to include clinical documentation improvement and coding denials prevention.
Job Responsibilities
- Performs retrospective coding and documentation review of denied charges for physician services. Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing.
- Analyze for invalid denial trends, payer specific carrier submission requirements & system optimization.
- Performs extensive follow-up to investigate and resolve payment denial trends.
- Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation, claim status and billing guidelines to substantiate corrected claim submissions, written appeals, coding and medical necessity reviews.
- Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals according to various payer claim guidelines.
- Ensures denial reviews are conducted in a timely manner.
- Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors.
- Participates in annual and on-going mandatory compliance training. Fulfills Continuing Education Units necessary to maintain certification status.
- Assists in training current and new employees on the use of systems and departmental policies and procedures.
- Performs other related duties as assigned.
Education
Experience
Knowledge, Skills and Abilities
Licenses and Certifications
Working Conditions / Physical Demands
Remote based work with rare onsite requirement. Dedicated workspace conducive to a healthy work environment.
Salary : $29 - $35
