Revenue Integrity Coding Specialist - CPC

Revenue Integrity Coding Specialist - CPC Required

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Employment Type
Full time

Shift
Day Shift

Description
This is a M-F, 8a-5p remote position that requires certification. For the Holy Cross Medical Group this individual performs charge entry, charge approvals, and/or quality charge reviews; including but not limited to, appending modifiers and checking clinical documentation. Works closely with Revenue Integrity staff and providers to educate on improved documentation to support coding. Neurosurgery experience is highly preferred. CPC license is REQUIRED.

What You Will Do
Responsible for coding and/or validation of charges for more complex service lines, advanced proficiencies in surgical or specialty coding practice. Review chart, including nursing notes, physician orders, progress notes, and surgical or specialty notes thoroughly to interpret and validate and/or extract all charges. Ensure each chart is complete according to specified guidelines. Ensure charges captured on the correct patient, encounter, date of service, with required modifiers.

Review documentation, abstract data and ensure charges/coding align within AMA and Medicare coding guidelines. Ensure medical documentation and coding compliance with Federal, State and Private payer regulations. a) Perform coding functions, including CPT, ICD‑10 assignment, documentation review and claim denial review b) Proof daily charges for accuracy and clean claim submission c) Balance charges and adjustments d) Maintain productivity standards e) Maintain compliance with regulatory requirements.

Responsible for denial coordination with PBS centers, analysis of clinical documentation, assisting in appeals, root cause analysis and tracking as needed. Educate clinical staff on accurate and complete documentation to ensure revenue optimization and integrity. Perform outpatient clinical documentation improvement review (acute only) as needed. Perform research on charges and communicate findings to intra and inter‑departmental colleagues. Maintain a minimum productivity standard, based on service line and charge type, including chart review, charge extraction, E&M level assignment and charge entry.

Minimum Qualifications

• High school diploma or equivalent combination of education and experience.
• Minimum three (3) years of relevant coding and charge control work experience in a Hospital and/or Physician Practice environment and experience in revenue cycle, billing, coding and/or patient financial services.
• Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations.
• Licensure / Certification: CPC license required.
• Neurosurgery experience preferred.
• Demonstrated knowledge of clinical processes, clinical coding (CPT, HCPCS, ICD‑9/10, revenue codes and modifiers), charging processes and audits, and clinical billing. Strong understanding of various medical claim formats.
• Knowledge of clinical documentation improvement processes strongly preferred.
• Strong knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and pre‑bill edits including OCE/CCI edits and Discharged Note Final Billed (DNFB).
• Ability to perform charge capture processes, including understanding technical integration of electronic medical record and automation of charge triggers, and ability to investigate charge errors. Epic experience desired.

Position Highlights And Benefits

• Comprehensive benefit packages available, including medical, dental, vision, paid time off, 403B, and education assistance.
• Benefits start on your first day of work.
• Retirement savings program with employer matching.
• We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.
• We live and breathe our guiding behaviors: we support each other in serving, we communicate openly, honestly, respectfully, and directly; we are fully present, all accountable, trust and assume goodness in intentions, and we are continuous learners.

Ministry/Faci…