Revenue Integrity Coding & Billing Specialist

Active coding certification from AHIMA or AAPC (e.g., CCS, CCS-P, CPC, COC, CIC) required. 7+ years of progressive medical coding and billing experience, including enterprise revenue integrity, denial management, or claim edit resolution. Expert knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and payer edit logic (NCCI, LCD/NCD, medical necessity). Demonstrated experience pulling, analyzing, and interpreting revenue cycle data for decision-making and root cause analysis. Experience supporting enterprise or multi-facility revenue cycle operations, preferably within DHA, DoD, VA, or a large integrated health system. Hands-on experience with Cerner revenue cycle workflows; experience with MHS GENESIS strongly preferred. Working knowledge of DHA/MHS revenue cycle data repositories and reporting tools (e.g., HealtheAnalytics, HDI/HARC, Alpha II, SSI, M2, MDR, EAS IV). Strong understanding of end-to-end revenue cycle processes. Proven ability to analyze payer remittances, EOBs, denial codes, and upstream data sources. Advanced analytical and documentation skills to translate data findings into actionable recommendations. Proficiency with Microsoft Excel (pivot tables, data analysis) and PowerPoint. Excellent written and verbal communication skills. Ability to obtain and maintain a Public Trust clearance.

Serve as a coding, billing, and revenue integrity subject matter expert for enterprise RI initiatives. Perform review and validation of ICD-10-CM, CPT, and HCPCS coding. Analyze DHA revenue cycle data to identify risks and impacts to enterprise revenue. Analyze and resolve complex coding- and billing-related claim edits and holds. Utilize DHA and MHS data sources to assess edit trends and denial drivers. Evaluate charge capture workflows for accuracy across the revenue lifecycle. Investigate and resolve high-risk denials related to coding, modifiers, medical necessity, or billing logic. Identify systemic trends and root causes in coding, charge defects, and billing failures. Collaborate with Revenue Integrity leadership, medical coding programs, patient accounting, and clinical stakeholders. Interpret and apply Official Coding Guidelines, TRICARE policy, NCCI edits, LCD/NCDs, and DHA billing guidance. Support revenue integrity reviews, audits, and compliance activities. Contribute to the development of enterprise coding and billing guidance, playbooks, and education. Prepare and present enterprise-level reporting and analysis on claim edits, denial trends, and financial exposure.