RCS-Operational Performance Expert CC

IU Health; Indianapolis (IN); Hybrid; USD 60,000 - 85,000; Full time

Job summary

A leading healthcare organization is seeking a professional for a remote/hybrid position focused on quality reviews and coding within the revenue cycle. The role requires specialized knowledge in health information management, coding compliance, and effective communication skills. Candidates should have significant experience in revenue cycle operations and relevant certifications. This position plays a vital role in ensuring the accuracy of clinical documentation and supporting quality initiatives across the organization.

Qualifications

• 5+ years experience in revenue cycle operations.
• 3-5 years of coding and/or quality review experience.
• Requires RHIA, RHIT, CCS, CCS-P, CPC, CIC, COG or CHDA.

Responsibilities

• Perform provider quality reviews for compliance with coding guidelines.
• Educate physicians and leaders on coding and payer guidelines.
• Assist with coding questions and research.

Skills

Interpersonal skills

Problem solving

Analytic skills

Attention to detail

Communication skills

Education

Associate or Bachelor Degree in Health Information Management, Coding, Nursing or Finance

High School Diploma/GED

Tools

Microsoft Office

Job description

Overview

Flexible M-F, Remote/Hybrid – Majority remote; on-site for quarterly meeting

This position will be responsible for performing a range of advanced and complex tasks that require specialized knowledge and exceptional problem-solving skills, potentially inclusive of but not limited to quality reviews, training and onboarding new team members, etc. This position will help to ensure efficiencies in operational workflow, as well as the accuracy and completeness of clinical medical record documentation and clinical coding as it pertains to assignment of patient status, documentation of care provided, support of billing for services provided and affect that data has on hospital reporting. This position will also be very involved in various quality initiatives across the Indiana University Health system.

Must haves

• High School Diploma/GED is required.
• Associate or Bachelor Degree in Health Information Management, Coding, Nursing or Finance is preferred.
• Coding/HIM Position - Requires RHIA, RHIT, CCS, CCS-P, CPC, CIC, COG or CHDA (based on position/focus). Clinical Position - Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license. BSN preferred (after 1/1/2013, ASN RN hired will be required to complete the BSN within five (5) years of hire date). Requires proficiency in the use of Microsoft Office applications (Word, Excel, PowerPoint, OneNote, Visio & Access). Requires 5+ years experience in revenue cycle operations in various positions related to utilization management, coding, billing, collections, payment adjustments, auditing, denial management and medical record completion.
• 3-5 years of coding and/or quality review experience with a preference of multispecialty coding of both surgical procedures as well as E/M coding

• Knowledge of revenue cycle requirements and regulations with a preference of understanding both coding and billing, but the later is not a requirement.

  Key Responsibilities

• Performance of provider quality reviews to ensure compliance with ICD-10 diagnosis coding, CPT coding including modifiers, CCI edits, other payer edits, Medicare and commercial payer policies as well as any regulatory coding guidelines across all specialties. This position will also require knowledge of the Emergency Department coding/documentation requirements nuances and providing education related to those specific requirements.
• Attending and providing education to physicians, APPs, other leaders around results of reviews, coding, payer guidelines, etc as needed
• Assist with any coding questions, research, etc as needed

Additional Requirements

• Requires ability to read, understand and interpret medical records and other treatment documentation.
• Requires a high level of interpersonal, problem solving, and analytic skills.
• Requires effective written and verbal communication skills in both individual and group settings to ensure professional correspondence and presentation to all levels of individuals within the organization (operational team members, leadership internal and external to Revenue Cycle, clinicians, physicians, auditors and other external individuals/groups).
• Requires the ability to establish and maintain collaborative working relationships with others.
• Requires ability to set and adjust defined priorities as necessary and to process multiple tasks at once.
• Requires strong attention to detail, problem solving and critical thinking skills.
• Requires ability to work with and maintain confidential information.
• Six Sigma or Lean Six Sigma training preferred.