RCM - Healthcare Senior Consultant - Outpatient Revenue Integrity

Senior RCM Senior Consultant Outpatient Revenue Integrity (Mid Revenue Cycle Specialist)

The role leads the identification and resolution of payment integrity issues to support increasing the accuracy of claims adjudication and provider payments.

Oversees internal support team and works with multiple client groups. Leads technical / operational procedures and processes, implements strategic plans, and improves performance.

• Managed inquiries regarding 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.
• Performed analysis of patient clinical, charging, and billing data to identify documentation, coding and charging opportunities Worked 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.
• Led / supported compliance, education, accuracy in charge capture and improvement in the revenue cycle processes as identified through revenue cycle audits and root cause analysis
• Worked with providers / physicians to review clinical documentation integrity (CDI) and facilitate education to improve clinical documentation and measure improvement
• Leverages clinical knowledge and standard procedures to ensure timely attention to denials as requested by Audits, CBO, and Revenue Integrity and applicable appeal data gathering
• Responsible for retrospective charge reviews, and Outpatient CDI reviews and assistance with third party charge audits
• Leveraged clinical knowledge and standard procedures to ensure timely attention to denials as requested by Audits, CBO, and Revenue Integrity and applicable appeal data gathering
• Worked closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided.
• Completed retrospective charge reviews, and Outpatient CDI reviews and assistance with third party charge audits

Essential Qualification :

• AHIMA Certified Coding Specialist
• Registered Nurse and Licensed Practice Nurse
• Coding Audit / Trainer

Additional Qualifications

• AHIMA approved ICD-10CM / PCS trainer preferred.
• Coding Certified Specialist, CCS required. 2+ years hand-on ICD-10PM / PCCS experience required.
• Experience using MS-Excel required. Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers.
• Excellent computer proficiency (MS Office Word, Excel and Outlook). Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service.
• Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices.
• 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.

Synergetics employees may reside in any city, however, proximity within one hour of an international-class airport is required.

This position will be 50% remote and 50% travel to the New Jersey / New York City area.