Revenue Integrity Coder

Facility: Administrative Regional Training Cntr

Shift: Shift 1

Status: Full Time FTE: 1.000000

Bargaining Unit: ACE Associates

Exempt from Overtime: Exempt: Yes

Work Schedule: Days

Hours:

7-4, 8-4 flexible

Summary:

Under the direction of the Manager/Director of Revenue Integrity, including oversight from System revenue cycle leadership, the Revenue Integrity Coder of Infusion Services will be responsible for optimization of charge capture, charge review, appropriate documentation and work queue edits for all infusion services, specifically Oncology and Chemotherapy. This position serves as the primary contact/resource for Patient Financial Services, Revenue Integrity and Infusion Clinical Staff.

The position requires advanced knowledge of Oncology, Chemotherapy, and Infusion drug requirements of various insurance providers as well as federal billing rules, Medicare and Medicaid. The incumbent actively participates as needed in both external third-party audits and in internal audits and as well as quality improvement initiatives, assists with special projects, and works closely with Catholic Health fiscal teams, Clinical Center Leadership, and Prior Authorization teams.

The position plays a critical role in identifying trends, monitoring insurer policy changes, and educating clinical and revenue cycle teams on appropriate CPT, HCPCS, and modifier usage. The Revenue Integrity Coder will take ownership of infusion-related denials, perform detailed account reviews, and drive process improvements to enhance revenue integrity and reduce financial risk. The Revenue Integrity Coder is also responsible for the provision of accurate and timely support for appeals processing to various pertinent health system teams or programs. The incumbent will also provide support, as needed, for various aspects within revenue cycle including reimbursement, financial analysis, denial trends, charges, and report generation.

Responsibilities:

EDUCATION & CERTIFICATIONS

• Associate degree required - Health Information Management, Healthcare Administration, or related field preferred
• Bachelor's Degree preferred
• One of the following certifications is required: CPC (Certified Professional Coder), CCS (Certified Coding Specialist), RHIT or RHIA preferred
  
  

Experience

• Minimum of 3-5 years of coding or revenue integrity experience, with a focus on oncology, chemotherapy, and infusion services
• Experience with hospital or outpatient infusion coding is strongly preferred
• Experience working in revenue integrity or audit-focused role preferred
• Experience dealing with health insurance, prior authorizations and claims resolution desirable
• Experience with documentation and documentation issue resolution desirable
• Knowledge of medical terminology
  
  

KNOWLEDGE, SKILL AND ABILITY

• Deep understanding of CPT, HCPCS, ICD-10-CM, and modifier usage for infusion and oncology services
• Strong knowledge of payer policies and reimbursement methodologies
• Strong communication, interpersonal, organizational, and computer skills
• Proficient in gathering, analyzing and interpreting data, and working both independently and as part of a team to solve problems, make and implement recommendations
• Proficient with computers, software applications, and report generation
• Ability to work cross-functionally and influence process improvements
• High Tolerance for ambiguity and uncertainty
• Detail oriented and quality driven , with a focus on accuracy and compliance
• Experience analyzing denials and identifying root causes
• Excellent communication skills with the ability to educate clinical and non-clinical staff
• Strong analytical and problem-solving abilities
• Proficient in EPIC
  
  

WORKING CONDITIONS:

• Office type conditions with considerable sitting and computer work
• Works unusual hours as required to complete assignmentsand projects and in preparation for meetings, surveys etc
• Travels to other Catholic Health Infusion locations as required