RCMI Senior Solution Technical Expert - Revenue Integrity Coding & Billing
New
S
Seneca HoldingsFederal Government Contracting
In the continental United States, remote authorizedFull-TimeSenior
Salary not disclosed
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Job Details
- Experience
- Five or more years of progressive medical coding and billing experience
- Required Skills
- Data AnalysisMicrosoft Excel
Requirements
- Bachelor’s degree in a clinical, healthcare, business, or related field (or Associate’s degree with 5 additional years of revenue cycle experience).
- Active coding certification from AHIMA or AAPC such as CCS, CCS-P, CPC, COC, CIC, or equivalent.
- Five or more years of progressive medical coding and billing experience, including significant involvement in revenue integrity and denial management.
- Expert knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, modifiers, NCCI edits, and LCD/NCD guidance.
- Demonstrated experience analyzing revenue cycle data for root cause analysis and enterprise-level decision making.
- Strong proficiency in Microsoft Excel, including pivot tables and advanced data analysis.
- Excellent written and verbal communication skills for briefing senior and cross-functional stakeholders.
- Ability to obtain and maintain a Favorable Suitability Adjudication based on a Tier 1 background investigation.
- Ability to obtain and maintain a Federal or DoD Public Trust clearance.
Responsibilities
- Serve as an enterprise coding, billing, and revenue integrity subject matter expert supporting inpatient, outpatient, professional, emergency, ancillary, and procedural services.
- Perform advanced review and validation of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding against official guidelines, TRICARE policy, and NCCI edits.
- Analyze and resolve complex claim edits, pre-bill holds, DNFB exposure, and suspended charges within MHS GENESIS and downstream systems.
- Reconcile and interpret revenue cycle data from repositories like HealtheAnalytics, HARC, and MHS GENESIS to identify coding and billing risks.
- Investigate high-risk denials and systemic trends in billing failures to develop corrective action recommendations.
- Support chart-to-bill reviews, compliance assessments, and audit readiness activities.
- Collaborate with internal stakeholders and clinical system owners to coordinate cross-functional issue resolution.
- Design executive-level reporting on claim edit trends, financial exposure, and recovery opportunities.
- Support configuration validation and workflow optimization within Oracle Health Cerner MHS GENESIS.
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