|Preferred Certifications:||COC or CIC,CPC,CPC-H,CCS
|Location:|| Anywhere in the U.S. 75023, , US* Note: This listing is for a remote position
For more than 20 years, Revint Solutions has been helping healthcare providers recover revenue and bolster their bottom lines. Revint Solutions’ recovery methodology and technology platforms work to optimize the revenue cycle. With the use of intelligent proprietary analytics, our recovery teams are truly the best and most experienced at finding and recovering lost or unidentified revenue. We take a holistic approach to revenue recovery and look at not only contract compliance, but charge and revenue integrity, as well as regulatory compliance such as Transfer DRG and DRG validation. Today, we serve over 1,600 hospitals and health systems nationwide and are proud of numerous awards and recognitions, including being consistently named one of the Best Places to Work both locally and nationally.
Revint Solutions is currently seeking a highly skilled Rules Architect to join our Underpayment Recovery team in identifying and developing risk opportunities for our clients surrounding healthcare regulations and reimbursement updates. The candidate needs to research CMS, state, and payor regulations to produce documentation on regulation changes for the Underpayment Recovery team and our clients. The Rules Architect needs to have a comprehensive understanding of CPT, HCPCS, HIM and ICD10 procedure and diagnosis codes, in addition to experience with managed care contracts, specifically knowledge of inpatient and outpatient payment methodologies.
- 2+ years of hospital coding or billing experience
- Bachelor’s degree required
- Knowledge of coding with CPT/HCPCS/ICD10 diagnosis and PCS
- Medical Coding Certification– CCS, CPC, CPC-H, COC or CIC
- Strong conceptual, as well as quantitative and qualitative analytical skills
- Excellent written and verbal communication skills
- Must possess the ability to make sound decisions and recommend appropriate strategies to the leadership team
- Proven ability to meet deadlines with minimal oversight
- Extensive knowledge of government compliance rules and issues as it pertains to health care billing and coding
- Understanding on how coding mistakes can affect hospital reimbursement in both managed care and government reimbursement methodologies
- Ability to provide recommendations for recovering lost revenue and maximizing future reimbursement through managed care contracting and coding edits
- Familiarity with Medicare and knowledge of IPPS and OPPS payment methodologies
- Knowledge of medical terminology
- Knowledge of healthcare applications and systems
- Current knowledge of compliance mandates, Federal Register updates, Medicare’s NCD/LCD requirements, NCCI edits, newly FDA approved drugs and biologics and AMA’s CPT and HCPCS coding requirements
- Medicaid, Veterans Administration and Worker’s Compensation knowledge, especially coding changes/requirements
- Acute attention to detail and ability to perform self-QA to recognize and correct errors with ease
- Execute detailed reports in Microsoft Access, Excel, Power BI and PowerPoint to quantify variance patterns and present findings to leadership and C-level suite clients
- Revenue Cycle or HIM professional experience in consulting, management, coding, etc. ideal
- Ability to develop innovative material and trainings from CMS, payor, or state regulations
- A positive and proactive attitude with the ability to connect with and motivate people
The culture at Revint Solutions embraces those that demonstrate a deep passion for solving the problems of healthcare with enthusiasm for building positive working relationships and winning as a team. Take the work seriously, but don’t take yourself too seriously. Creating a strong workplace culture has been one of our staples, which we believe encourages and inspires employees to do their best. Join a fulfilling team of like-minded individuals who can get their work done, but still have fun!
Revint solution provides an extremely competitive benefit package that includes a 401(k) match, medical/dental/vision insurance and more.
Revint Solutions is an Equal Opportunity Employer