Revenue Integrity Specialist (RIS) -
ProFee
REMOTE POSITION
SUMMARY: The
Revenue Integrity Specialist (RIS) is a coder responsible for conducting medical
record compliance audits for documentation, billing, and compliance with state
and federal requirements for professional fee coding. The RIS shares audit
results with providers and conducts ongoing education. In addition, the RIS is
responsible for reviewing all external coding audits and responding to audit
findings.
Specialties: Pulmonology, Cardiology, urology,
Behavioral Health, GI and General Surgery
Education/Certification: The following are recognized certifications from
American Health Information Management Association (AHIMA) and/or American
Academy of Professional Coders (AAPC): Registered Health Information
Technologist (RHIT), Registered Health Information Administrator (RHIA),
Certified Professional Coder (CPC), CCS-P (Certified Coder Specialist –
Physician (CCS-P) with the appropriate level of experience.
Experience: A minimum of
three years coding experience in the outpatient setting (physician’s office or
ambulatory surgery centers) within the last five years, including assignment of
E&M, CPT, and HCPCS codes. Multiple specialties encompass different medical
specialties (i.e. Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.)
that utilize ICD, E&M, CPT, and HCPCS codes. Ancillary specialties (PT/OT,
Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not
count as qualifying experience. Additionally, coding, auditing and training
exclusively for specialties such as home health, skilled nursing facilities,
and rehabilitation care will not be considered as qualifying experience. Coding
experience limited to making codes conform to specific payer requirements for
the business office (insurance billing, accounts receivable) is not a
qualifying factor.
SKILLS: Review, analyze and interpret the medical record to identify all
diagnoses and procedures documented during the service. Must possess thorough knowledge of ICD-10-CM, CPT, HCPCS,
Modifiers, and other coding principles and applications as they apply to
Professional Fee coding. Thorough
Knowledge of ICD-10-CM Official Coding Guidelines and payer specific
requirements. Meets regularly with
providers to review analysis and provide education.