Impactful Coding Integrity Specialist

Embedded Shishya; United States; Remote; USD 39,000 - 55,000; Full time

Job summary

R1 RCM Inc. in the United States is seeking a Coding Integrity Specialist to lead coding quality reviews and collaborate with CDI teams.

The role requires analyzing large datasets, reviewing complex medical records, and prioritizing tasks to support accurate reimbursements and KPI achievement.

You will work with hospital leadership to ensure correct DRG coding, provide coder education, and drive improvements across the revenue cycle.

Qualifications

• Bachelor's or associate’s degree in HIM or CCS credential required.
• Minimum 5 years of inpatient coding.

Responsibilities

• Conduct complex coding reviews related to reimbursement, public reporting, and pay for performance.
• Collaborate with CDI team to resolve documentation inconsistencies and DRG variances.
• Ensure DRG/reimbursement accurately reflects services to optimize case mix reporting.
• Validate coding for specific service lines and technology with hospital leadership.
• Perform pre-bill and post-bill reviews for quality, risk, and possible write-offs.
• Conduct 360 coding reviews to identify documentation, denials, billing, and charging issues.
• Evaluate coding accuracy to prevent revenue loss in value-based programs.
• Provide education/feedback to coders and managers on corrections.

Skills

Inpatient coding

Analytical skills

Education

Bachelor's degree in HIM or CCS credential

CCS credential

Job description

R1 RCM Inc. in the United States is seeking a Coding Integrity Specialist to lead coding quality reviews and collaborate with CDI teams.

The role requires analyzing large datasets, reviewing complex medical records, and prioritizing tasks to support accurate reimbursements and KPI achievement.

You will work with hospital leadership to ensure correct DRG coding, provide coder education, and drive improvements across the revenue cycle.