- Review clinical documentation to ensure coding accuracy and billing compliance.
- Evaluate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding practices.
- Assess documentation quality and identify coding gaps affecting reimbursement.
- Support claim reconstruction by validating coded encounters and supporting documentation.
- Collaborate with HIM, Coding, Clinical Documentation Integrity (CDI), Revenue Integrity, and Patient Financial Services teams.
- Review denied claims and identify documentation or coding issues contributing to payment delays.
- Recommend process improvements that enhance coding accuracy and revenue cycle performance.
- Assist with documentation audits and coding validation efforts.
- Produce findings and recommendations for project leadership.
Requirements
- 7+ years of Health Information Management (HIM) and hospital coding experience.
- Extensive knowledge of: ICD-10-CM ICD-10-PCS CPT HCPCS MS-DRGs APCs
- Strong understanding of hospital revenue cycle operations and reimbursement methodologies.
- Experience with Clinical Documentation Improvement (CDI) initiatives.
- Experience working with acute care hospitals or integrated health systems.
- Strong analytical, communication, and documentation skills.
- Preferred Qualifications RHIA, RHIT, CCS, CCS-P, CPC, or other HIM/coding certifications.
- Experience with revenue cycle optimization or recovery initiatives.
- Experience with hospital EHR platforms such as Paragon, Epic, Cerner, or Meditech.
- Healthcare consulting experience.
- Knowledge of Revenue Integrity and coding compliance.
Core Competencies
Demonstrates extensive expertise in Health Information Management and hospital coding, with a strong focus on ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding practices. Proven ability to enhance coding accuracy and revenue cycle performance through collaboration and process improvement initiatives.
Highest-signal resume keywords
- Health Information Management (HIM)
- ICD-10-CM Coding
- CPT Coding
- Clinical Documentation Improvement (CDI)
- Revenue Cycle Optimization
ATS Optimization Keywords
Hard Skills
- ICD-10-PCS Coding
- HCPCS Coding
- MS-DRGs Knowledge
- APCs Knowledge
- Coding Compliance
- Documentation Audits
- Coding Validation
- Reimbursement Methodologies
- Analytical Skills
- Documentation Skills
Soft Skills
- Communication Skills
- Collaboration Skills
- Problem-Solving Skills
Certifications & Qualifications
- RHIA
- RHIT
- CCS
- CCS-P
- CPC
Industry Keywords
- Revenue Integrity
- Healthcare Consulting
- Coding Practices
- Billing Compliance
- Claim Reconstruction
Tools & Technologies
- EHR Platforms
- Paragon
- Epic
- Cerner
- Meditech