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Type: Contract
Pay: Apply For Details
Location: Remote
Revenue Cycle Specialist (Certified Medical Coder)
Position Summary
Productivity Expectation: 30 encounters per hour
The Revenue Cycle Specialist is responsible for reviewing clinical documentation and accurately assigning CPT, HCPCS, ICD-10-CM codes, modifiers, and charges for professional services across inpatient, outpatient, ambulatory surgery, and other healthcare settings. This role ensures compliance with coding guidelines, payer regulations, and organizational policies to support accurate reimbursement and revenue integrity. The specialist also performs coding audits, investigates claim denials, and collaborates with clinicians and operational teams to improve documentation and coding accuracy.
Key Responsibilities
Coding & Charge Capture
- Review clinical documentation to ensure services are appropriately supported and billed.
- Assign accurate CPT, HCPCS, ICD-10-CM codes, modifiers, and charges in accordance with payer and regulatory requirements.
- Resolve coding edits, including CCI, LCD, NCD, and system-generated coding validations.
- Maintain expertise in annual coding updates, payer regulations, and reimbursement methodologies.
- Apply risk adjustment and data validation principles to support accurate coding outcomes.
Documentation Improvement & Education
- Provide coding guidance and education to clinicians based on documentation trends and coding opportunities.
- Collaborate with providers and departmental leaders to resolve complex coding and billing issues.
- Assist with the development and optimization of documentation tools, templates, and workflows.
Auditing & Denial Management
- Perform retrospective coding audits related to denied claims, provider requests, and patient concerns.
- Analyze denial trends and provide actionable feedback to clinicians and operational teams.
- Support compliance reviews and internal auditing initiatives.
Collaboration & Continuous Improvement
- Partner with Coding Education, Compliance, Data Analytics, and Operational teams to improve coding quality and documentation practices.
- Contribute to onboarding and training efforts for new clinicians and operational leaders.
- Participate in process improvement initiatives related to revenue cycle operations.
Required Qualifications
Education & Experience
- Completion of a coding education program, degree in Health Information Management or related field, or equivalent coding experience.
Certification
- One of the following active certifications:
- CCA
- CRC
- COC
- CCS
- CPC
- CCS-P
- RHIT
- RHIA
Knowledge & Skills
- Strong knowledge of CPT, HCPCS, ICD-10-CM coding guidelines and reimbursement regulations.
- Understanding of anatomy, physiology, disease processes, and medical terminology.
- Intermediate proficiency with Microsoft Office applications.
- Strong analytical, critical thinking, decision-making, and time management skills.
- Ability to work independently while maintaining high accuracy and productivity standards.
Preferred Qualifications
- One or more years of professional coding experience.
- Experience with Epic or similar electronic health record systems.
- Experience using coding reference tools and coding software applications.
- Strong Evaluation & Management (E&M) coding expertise.
- Excellent communication and presentation skills with the ability to educate providers and clinical teams.
Core Competencies
- Revenue Cycle Management
- Medical Coding & Compliance
- Documentation Review & Auditing
- Provider Education
- Denial Prevention & Resolution
- Regulatory Compliance
- Risk Adjustment Coding
- Collaboration & Relationship Building
- Continuous Learning & Process Improvement
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Job Id: a1sVb000005ElqbIAC