Revenue Integrity Coding Specialist

Day to Day:

Position Overview: We are seeking a dedicated Revenue Integrity Coding Specialist to join a healthcare provider in south Florida. This role focuses on ensuring accurate coding for outpatient surgery and facility settings. The ideal candidate will have recent experience in outpatient surgery/facility coding and a strong understanding of diagnosis coding and medical necessity.

The Revenue Integrity Coding Specialist will be accountable to the Manager of Revenue Integrity. This role involves reviewing queries related to ICD-10CM/PCS and HCPCS/CPT code assignments, medical necessity, abstracted data, or any other elements of coded data that could affect the revenue cycle or data analytics. The specialist will collaborate with the pre-bill edit team to address issues and inform the revenue cycle departments when adjustments are necessary.

Key Responsibilities:

Review and correct codes for outpatient surgery and facility settings.

Ensure compliance with quality standards, maintaining a rate of 5 accounts per hour.

Audit work lists and reports, making necessary corrections to coding.

Apply appropriate modifiers and resolve coding edits for pre-bill.

Utilize Cerner and Optum systems; experience with Soarian is a plus.

Additional Information:

This role involves a mix of auditing and coding, ideal for someone looking to transition from full-time coding to a more varied role.

Candidates should have a strong handle on outpatient surgery coding, as inpatient coding tasks are minimal.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.

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Must Haves:

Bachelor's Degree in Health Information Management OR related field OR equivalent work experience.

Hospital outpatient facility coding

Outpatient surgery coding experience (multi-specialty)

2 years of relative experience

Hospital setting experience

CCS OR RHIT AHIMA

If RHIT: Candidate needs to be willing to obtain CCS within two years at BHSF.

Diagnosis coding experience and medical necessity knowledge experience- ICD-10CM/PCS and HCPCS/CPT

2 years of hands-on ICD-10PM/PCCS required

Auditing experience is beneficial but not mandatory.

MS-Excel Experience

Proficiency in MS Office Word, Excel and Outlook

Ability to work independently, work under pressure, meet deadlines, maintain positive and uplifting attitude, and show exemplary customer service skills.

Experience with worklists, reporting, and understanding of edits

Experience with Optum

Experience with Cerner

Experience with Sorian

Oncology experience (this is a big portion of medical necessity work / requirements)

Auditing experience

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.