Revenue Integrity Medical Coder

Summary

Join Tria Federal's Defense Health Agency Revenue Integrity Team as a detail-oriented Medical Coder. This critical role ensures accurate and compliant medical coding to optimize revenue capture. Leverage your expertise in coding guidelines, billing rules, and the MHS GENESIS EHR system to validate charges and mitigate revenue cycle risks. You will proactively manage coding and billing work queues, adhering to HIPAA regulations and staying current with coding updates. The ideal candidate possesses a valid coding credential, 3+ years of experience, and proficiency with Cerner Millennium. This is a remote, full-time position requiring US citizenship and the ability to obtain a Public Trust clearance.

Requirements

• Certification: Must possess and maintain a valid coding credential from AHIMA (e.g., RHIA, RHIT, CCS, CCS-P) or AAPC (e.g., CPC, COC, CIC, CPC-P)
• Experience: Minimum of 3+ years of recent medical coding experience, with demonstrated experience in tasks related to revenue integrity, charge capture review, denial management, and resolving coding-related billing edits
• EHR Experience: Demonstrated proficiency and hands-on experience using Cerner Millennium. Experience specifically with MHS GENESIS, including navigating coding, charge, and billing-related modules/work queue, is highly desirable
• Work Queue Management: Proven ability to efficiently manage and resolve revenue cycle work queues, including coding edits, charge review, and pre-billing holds within an EHR system
• Knowledge: Expert knowledge of ICD-10-CM and CPT/HCPCS coding systems and guidelines
• Strong understanding of medical terminology, anatomy & physiology, and disease processes
• Strong understanding of healthcare revenue cycle processes, reimbursement methodologies, and payer requirements (especially TRICARE)
• Familiarity with NCCI edits, LCDs/NCDs, and modifier usage impacting payment
• Knowledge of HIPAA, and healthcare compliance regulations related to coding and billing
• Skills: Exceptional attention to detail and accuracy
• Strong analytic, investigative, and problem-solving skills
• Proficient computer skills, including EHR navigation and Microsoft Office Suite
• Excellent written and verbal communication skills
• Ability to work independently, prioritize tasks, and meet deadlines in a production-driven environment
• Ability to analyze and interpret complex data, processes, and reports related revenue cycle and integrity
• Access: Ideal candidate would have an active security clearance with the DHA
• Bachelor’s degree required, Finance, Business Administration, Healthcare Administration or related field preferred. Masters in Business Administration or related field, ideal
• Ability to Obtain and Maintain a Public Trust
• 2-4 or more years of consulting or healthcare experience required, preferably in a federal consulting environment
• US Citizenship and the ability to obtain and maintain the clearance level stated above are required for this specific opportunity

Responsibilities

• Coding for Revenue Accuracy: Review clinical documentation to accurately assign ICD-10-CM, CPT, and HCPCS Level II codes, with a specific focus on ensuring codes support medical necessity, charge capture, and compliance billing practices
• Apply modifiers correctly to ensure appropriate reimbursement and prevent denials
• Ensure coding complies with Official Coding Guidelines, payer regulations (including TRICARE), NCCI edits, and DoD/DHA policies impacting revenue
• Revenue Cycle & Work Queue Management: Proactively utilize MHS GENESIS (Cerner Millennium) to review documentation, assign codes, and investigate coding-related revenue issues
• Actively monitor, prioritize, research, and resolve coding and billing-related edits found in electronic work queues (e.g., claim edits, charge review queues, pre-bill holds, coding validation queues, and denials management queues)
• Meet established productivity and quality standards for coding accuracy, work queue resolution timeliness, and financial impact
• Charge Validation and Reconciliation: May assist in validating that charges generated are appropriate and supported by clinical documentation and coding assignments
• Identify discrepancies between documented/coded services and captured charges, investigating and recommending corrective actions
• Compliance and Auditing Support: Adhere strictly to HIPAA regulations and maintain patient confidentiality
• Stay current with coding updates, payer rules, reimbursement methodologies (DRG, APC, etc.), and federal/local regulations impacting revenue integrity
• Collaboration and Process Improvement: Serve as a subject matter expert on coding guidelines related reimbursement and billing
• Provide feedback to client stakeholders regarding documentation improvement opportunities impacting revenue integrity
• Identify trends in work queue edits or denials and contribute to process improvement initiative to prevent recurrence
• Actively participate within project team(s) and engages with team members to ensure project objectives and client needs are met. Provides support and guidance as needed to ensure quality work products
• Adheres to all established project processes, procedures, and guidelines regarding resources and how to use them. Communicates with leadership regarding resource needs and communicates changes
• Adheres to defined work plans while maintaining all established timelines and deliverable deadlines
• Assists in developing effective internal and external presentations and skillfully helps to facilitate client and internal team meetings
• Ability to meet internal and external deadlines by efficiently managing time, prioritizing tasks, and utilizing available resources
• Accurately documents client communications and shares information with the project team
• Maintains effective communication with client and project team members

Preferred Qualifications

• Experience coding and/or working work queues within the Military Health System (MHS), Department of Defense (DoD), or Department of Veterans Affairs (VA)
• Experience coding and/or working work queues in multiple specialties or encounter types (e.g., E/M, Surgery, Inpatient Facility)
• Bachelor’s degree in Health Information Management (HIM) or related field
• Additional specialty coding credentials (e.g., CEDC, CASCC, etc.)

Benefits

Top-tier benefits package to invest in your physical, mental, and financial health and wellness