Remote Revenue Integrity Specialist - Coding & Edits

Medix™; California; Remote; USD 60,000 - 85,000; Full time

Job summary

Medix is seeking a detail-oriented Revenue Integrity Specialist to support healthcare revenue cycle operations by reviewing claim edits, validating coding accuracy, and ensuring proper charge capture and billing practices. This remote role requires residing in California and delivering timely reimbursements with high quality.

You will apply CPT modifiers, resolve coding discrepancies, and collaborate with clinical, IT, and revenue cycle teams to drive process improvements and accurate reporting.

Qualifications

• Active coding certification required (CPC or equivalent).
• Experience in medical coding and healthcare revenue cycle operations.
• Working knowledge of CPT coding, modifier application, and claim edit resolution.
• Familiarity with NCCI edits and modifier exceptions.
• Ability to meet daily productivity expectations of at least 175 accounts or claim edits while maintaining a minimum 95% quality.

Responsibilities

• Review and resolve revenue integrity claim edits, coding discrepancies, and billing issues to support accurate and timely claim submission.
• Process a minimum of 175 accounts or claim edits per day while maintaining a quality and accuracy score of at least 95%.
• Apply appropriate CPT modifiers, including Modifier 25 for separately identifiable E/M services and Modifier 50 for bilateral procedures, when supported by coding guidelines and documentation.
• Review claims containing duplicate CPT codes with LT and RT modifiers and determine when appropriate modifier corrections are necessary.
• Identify coding errors, charge omissions, and billing discrepancies, coordinating with appropriate departments to facilitate corrections.
• Review code pair edits and apply appropriate modifier exceptions in accordance with NCCI guidelines, avoiding inappropriate unbundling of services.
• Research and troubleshoot accounts held in billing work queues due to coding, charging, or documentation discrepancies.
• Monitor late charges and recurring billing issues, identify root causes, and assist with tracking trends and opportunities for improvement.
• Maintain accurate issue logs documenting findings, corrective actions, and resolution progress.
• Assist with the review and maintenance of chargemaster information, charge documents, and charge capture processes.
• Prepare reports on claim edits, coding accuracy, late charges, and other revenue cycle performance metrics.
• Collaborate with revenue cycle, clinical, and IT teams to resolve routine system issues and support process improvements.
• Assist with maintaining system support tickets and escalating complex issues to the appropriate teams.

Education

CPC certification

Tools

Excel

Outlook

Word

Teams

Job description

Medix is seeking a detail-oriented Revenue Integrity Specialist to support healthcare revenue cycle operations by reviewing claim edits, validating coding accuracy, and ensuring proper charge capture and billing practices. This remote role requires residing in California and delivering timely reimbursements with high quality.

You will apply CPT modifiers, resolve coding discrepancies, and collaborate with clinical, IT, and revenue cycle teams to drive process improvements and accurate reporting.