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Revenue Integrity Coding Specialist
Health System Solutions (HSS)

Location: Miami, Florida
Work Setting: Ambulatory Care
Job Function:
Coder, Coding – QA, Coding – Auditor
Job Type:


Position Summary

The Revenue Integrity Coding Specialist will report to the Manager of Revenue Integrity Management.

The Revenue Integrity Coding Specialist will review inquires associated with ICD-10CM/PCS and HCPCS/CPT code assignment, medical necessity, abstracted data or any other component associated with coded data that may impact the revenue cycle or data analytics. S/he will work along with the pre-bill edit team to take appropriate action to resolve the issues and communicate to the revenue cycle departments when changes need to be made.   

Job Description

  • Review and resolve all inpatient and outpatient inquires associated with ICD-10 CM/PCS and HCPCS/CPT code assignment, medical necessity, abstracting data or any other component associated with coded data that may impact revenue cycle or data analytics
  • Review medical records and take appropriate action for resolution adhering to ICD-10CN/PCS, HCPCS/CPT coding guidelines and conventions while ensuring compliance with state and federal regulatory agencies
  • Work with Revenue Integrity management team in identifying trends which will in operation and performance improvement
  • Manage daily financial error worklists and any other reports as well as access applications that contain encounters with edits assigned to coding
  • Review encounters to determine appropriate action and communicate with respective revenue cycle department on non-HIM related accounts to expedite resolution
  • Respond to intra and interdepartmental inquires on appropriate coding and abstracting assignment according to performance standards and goals set by department
  • Ensure work performance meets optimal reimbursement with a coding accuracy rate of 95% in accordance with national standards
  • Correct encounters according to productivity standards and goal set by department of # encounters worked per hour
  • Serve as a resource to revenue cycle departments as it pertains to ICD-10CM/PCS, HCPCS/CPT, medical necessary and any other component associated with coding
  • Maintain CEUs and update coding knowledge through reading articles/newsletters and attending seminars and meetings

Required Qualifications

Skills & Qualifications:
  • Proficient in ICD-10CM/PCS, HCPCS/CPT coding conventions and guidelines, National and Local Coverage Determinations, and encoder products required
  • Demonstrated flexibility to perform other tasks as needed in an active work environment with changing work needs
  • Self-motivated to work independently and work as a team member
  • Organizational, interpersonal, written and verbal communication skills required
Education and Experience:
  • High school Diploma
  • Coding Certified Specialist, CCS required
  • 2 years hand-on ICD-10PM/PCCS experience required
  • Experience using MS-Excel required
Licensure, Certification, and/or Registration:
Physical and Mental requirements:
  • Constantly operates a computer and other office equipment to coordinate work.
  • Usually remains stationary for most of the day.
  • Frequently communicates with clients and coworkers and must be able to share information effectively.
  • Occasional stooping, reaching or kneeling may be necessary to reach into overhead or low cabinets.
  • Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data.
  • Works in an office environment.

Preferred Qualifications

  • Bachelor’s degree in Health Information Management or related field (preferred)
  • AHIMA approved ICD-10CM/PCS trainer (preferred)


Health Insurance, PTO, 10 Paid Holidays off, 401k w/ company matching all after 60 days plus quarterly bonus opportunities!

Apply Online:

Posted: October 18, 2019 at 1:42 PM
Post ID: 44120

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