Description
PURPOSE OF THIS POSITION
The purpose of the Revenue Integrity Coordinator is to be responsible for reviewing clinical encounters to proactively prevent post-billing denials. This role serves as a subject matter expert and resource in coding, billing, and denial management for both clinical and administrative staff at Armes Cancer Center. The Coordinator will assess previously submitted encounters, offering recommendations to resolve past discrepancies and implement strategies to minimize future claim denials. This role plays a critical role in supporting accurate revenue cycle processes and ensuring compliance with coding and billing standards.
JOB DUTIES/RESPONSIBILITIES
Duty 1: Reviews oncology clinical documentation, including chemotherapy, radiation therapy, infusion services, and diagnostic procedures, and verifies CPT, ICD-10, and HCPCS codes are in accordance with payor requirements.
Duty 2: Monitors claims prior to submission, identifies issues or discrepancies, and resolves them to reduce denials and reimbursement delays.
Duty 3: Ensures diagnosis codes, supported by documentation, are present in the problem list located in PowerChart.
Duty 4: Ensures claims are coded and billed correctly for complex oncology services requiring prior authorization, including drug administration, radiation therapy, biologics, labs, etc.
Duty 5: Collaborates with oncology providers, clinical staff, pharmacy, billing teams, coding, patient access, and compliance to ensure that documentation supports proper coding and billing.
Duty 6: Assists in resolving payer denials and responds to inquiries from revenue cycle teams. Analyzes historical encounters and offers actionable recommendations to correct past issues that resulted in claims denials.
Duty 7: Supports financial goals by improving clean claim rates and reducing days in accounts receivable for oncology related charges.
Duty 8: Stays up to date on frequent changes in oncology coding, billing requirements, and reimbursement models and ensures that services are provided in accordance with state and federal regulations, organization policy, and compliance requirements.
Duty 9: Serves as a resource for department, patients, and payors seeking to resolve questions and/or concerns regarding payment.
Duty 10: Participates in daily huddles, idea board meetings, staff meetings, and meetings with external departments to manage daily improvements.
Duty 11: Communicates in a professional manner with patients, representatives from third party payor organizations, provider relations, contract management, other internal customers, and co-workers, etc. in a manner to achieve revenue cycle department AR goals.
Duty 12: Identifies opportunities for system and process improvement and submits to management.
Duty 13: Maintains compliance with HIPAA and institutional policies regarding patient information and financial data.
REQUIRED QUALIFICATIONS
Two (2)+ years Healthcare Revenue Cycle experience. Direct professional and/or facility denial management experience preferred.
One (1)+ years of insurance billing and reimbursement processes, including understanding of cash posting, explanation of benefits (EOB), remittance advice, and denial codes.
One (1)+ year of coding experience or completed education in medical coding/billing program. CPC or CCS Certification or obtained within the first 12 months of hire.
CPFSS certification within 12 months of hire.
An understanding of payor contract terms, fee schedules, and payer reimbursement guidelines. Understands and recognizes medical and insurance terminology.
Knowledge of revenue codes, CPT/APC/HCPCS, ICD/DRG coding, NCCI, HIPAA, and other applicable concepts. Knowledge of CMS 1500 forms, UB-04's, remittance advice, and itemized statements.
Knowledge of revenue cycle workflows and systems used within the Revenue Cycle such as Cerner, Trisus, Forvis, Quadax, KaiNexus, 3M, Experian, etc.
Regulatory compliance and reimbursement of methodologies knowledge required. Ability to research, review, analyze, and interpret Federal, State and Local billing regulations required.
Ability to compile, analyze and effectively present data and complex information in an informative and meaningful way to a variety of audiences, including leadership.
Ability to manage complex issues and manage multiple tasks/projects. Excellent organizational and time management skills; detail oriented and follow-through. Self-directed.
Strong problem-solving, research, and analytical skills.
Positive service-oriented interpersonal and communication (written and verbal) skills required. Ability to effectively present and interact with all levels of the organization, including senior leadership.
PREFERRED QUALIFICATIONS:
Associate's degree in a healthcare related field preferred
Experience in oncology coding and billing.
Strong understanding of cancer treatment protocols, chemotherapy billing, and prior authorization processes.
PHYSICAL DEMANDS
This position requires a full range of body motion with intermittent walking, lifting, bending, squatting, kneeling, twisting and standing. The associate will be required to walk for up to one hour a day, sit continuously for six hours a day and stand for one hour a day. The individual must be able to lift twenty to fifty pounds and reach work above the shoulders. The individual must have good eye-hand coordination and fine finger dexterity for simple grasping tasks. The individual must have excellent verbal communication skills to perform daily tasks. The associate must have corrected vision and hearing in the normal range. The individual must be able to operate a motor vehicle for business travel and community involvement.
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