Revenue Cycle Specialist

Eye Health America LLC; United States; On-site; USD 65,000 - 95,000; Full time

Job summary

Eye Health America LLC seeks a skilled Revenue Integrity Auditor to review claims, verify documentation and coding, and help maximize reimbursement. The role involves identifying denials, training staff, and ensuring compliance with CMS and payer guidelines.

The incumbent will analyze rates, prepare KPI reports, and drive process improvements across the revenue cycle. Ideal candidates have a healthcare administration/health information management background with CPC certification and several

Qualifications

• Bachelor's degree in a related field; CPC certification may be preferred.
• Several years of experience in healthcare billing, coding, or revenue cycle management, focusing on revenue integrity.

Responsibilities

• Review and audit claims, medical records, and documentation for errors and compliance.
• Verify services are documented, coded, and billed per payer and regulatory rules.
• Identify opportunities to maximize revenue and reduce claim denials.
• Analyze reimbursement rates and fee schedules to ensure proper reimbursement.
• Provide training to staff on coding and documentation best practices.
• Stay updated on coding and billing guideline changes.
• Monitor CMS and third‑party payer compliance.
• Ensure coding practices align with regulatory standards.
• Prepare KPI reports on revenue integrity metrics such as coding accuracy and denial rates.
• Suggest process improvements to streamline workflows and reduce errors.
• Collaborate with departments to resolve issues in revenue cycle.
• Assist coders with complex coding scenarios.
• Conduct regular chart reviews to improve documentation quality.

Skills

Coding accuracy

Revenue integrity

Documentation review

CMS compliance

Data analysis

Education

Bachelor's degree in healthcare administration/health information management/nursing

CPC certification preferred

Job description

Essential Functions and Responsibilities

• Review and audit claims, medical records, and documentation to identify errors, discrepancies, or compliance issues.
• Verify that services provided are correctly documented, coded, and billed according to payer and regulatory requirements.
• Work to maximize revenue by identifying opportunities for additional billable services, coding accuracy, and reducing claim denials.
• Analyze reimbursement rates and fee schedules to ensure the organization is being reimbursed appropriately.
• Provide training and education to clinical and administrative staff on coding and documentation best practices.
• Stay updated on changes in coding and billing guidelines and share this information with relevant staff.
• Monitor compliance with healthcare regulations, including CMS (Centers for Medicare & Medicaid Services) and third-party payer requirements.
• Ensure that all billing and coding practices align with regulatory standards.
• Analyze data and prepare reports on key performance indicators related to revenue integrity, such as coding accuracy, claim denial rates, and reimbursement trends.
• Identify and implement process improvements to enhance revenue integrity, streamline workflows, and reduce errors.
• Collaborate with relevant departments to resolve issues and enhance revenue cycle processes.
• Assist coders and clinical staff with complex coding scenarios and documentation requirements.
• Conduct regular chart reviews and provide feedback to improve documentation quality.

Requirements

• Bachelor's degree in a related field, such as healthcare administration, health information management, or nursing. Relevant certifications (e.g., Certified Professional Coder - CPC) may be preferred.
• Several years of experience in healthcare billing, coding, or revenue cycle management, with a focus on revenue integrity.