Revenue Cycle Consultant - Medical Coding SME

Location: Remote/Falls Church, VA

Job Description:

Role Overview:
Intellect Solutions is seeking a highly motivated and skilled Revenue Cycle Consultant with Subject Matter Expertise (SME) in Medical Coding to join our team. As a Revenue Cycle Consultant - Medical Coding SME, you will leverage your deep understanding of coding principles, regulations, and their impact on the revenue cycle. You will assist our Defense Health Agency (DHA) client in optimizing their operational and revenue cycle performance, with a specific focus on coding and billing accuracy, compliance, and efficiency. This role involves analyzing coding practices and data, coordinating practices between DHA billing and coding stakeholders, identifying process improvement opportunities related to coding, charge capture and billing, and developing recommendations to enhance revenue integrity and operational effectiveness. Ideal candidate would have an active security clearance with the DHA.

Responsibilities:

• Apply Expert Coding Knowledge: Utilize in-depth knowledge of ICD-10-CM/PCS, CPT, HCPCS Level II, modifiers, and official coding guidelines (including DoD/DHA-specific policies and regulations, AMA CPT guidelines, AHA Coding Clinic, NCCI edits) to serve as the lead technical expert and analyze revenue cycle processes and data relevant to back-end billing operations.
• Coding Impact Analysis & Auditing: Assess how coding practices affect charge capture, billing, reimbursement, denials, and overall revenue integrity. Conduct coding quality audits on professional (physician) and institutional (facility) claims to ensure coding accuracy, documentation adequacy, and compliance. Analyze coding-related suspended charges, claim edits, claim denials, rejections, and accuracy trends impacting back-end billing process; identify root causes, patterns; develop targeted corrective action plans, mitigation strategies, and educational feedback.
• Process Improvement & Solution Development: Identify problems and opportunities specifically related to medical coding processes, documentation, and compliance within the within back-office operations. Develops data-driven solutions and implements changes to align coding and billing practices with best practices and client's business operations objectives.
• Coding, Reimbursement, & Regulatory Research: Conducts research and analysis to proactively stay current with industry changes impacting coding, billing, and reimbursement, including official coding updates (ICD-10-CM/PCS, CPT, HCPCS), payer rules and policies (Commercial, Medicare, Medicaid, and specifically DHA/TRICARE), evolving reimbursement methodologies (e.g., DRG, APC), NCCI edits, and relevant federal/local regulations (with emphasis on CMS and DHA directives). Analyze the impact of these trends on client operations and revenue cycle performance, sharing relevant insights and recommendations internally and with the client.
• Charge Description Master Maintenance & Coordination: Collaborate with the rates and pricing team on ad hoc, quarterly, and annual updates to the MHS Charge Description Master in coordination with the CDM team and business stakeholders. The position requires strong knowledge of billing, coding, and financial operations, along with expertise in medical terminology and healthcare billing systems. Coordinate with clinical and financial departments to implement appropriate charges for services rendered and perform quality control checks on added, modified, and deleted information or updates.
• Coding Training & Education: Develop and deliver focused coding education and training materials/sessions for diverse stakeholder groups, based on revenue cycle findings/analyses, regulatory updates, and identified issues.
• DHA Client & Environment Understanding: Demonstrate knowledge of the client organization, its strategic goals, governance structure, coding policies, and overall operating environment, particularly as it relates to coding and back-end billing functions.
• Collaboration & Teamwork: Demonstrates ability to effectively work independently as the primary coding expert. Work effectively within cross-functional teams and with client stakeholders to ensure revenue cycle-related project objectives are met. Provide coding expertise, support, and guidance to team members and to ensure quality work products.
• Project Execution: Adhere to defined work plans, project processes, procedures, and timelines, ensuring timely delivery of high-quality work products and deliverables, particularly those related to revenue cycle coding analysis and recommendations.
• Communication & Presentation: Develop and deliver effective presentations on findings, recommendations, and performance to internal teams and client stakeholders. Accurately document client communications and share information effectively. Maintain strong oral, written, and interpersonal communication.
• Time Management: Efficiently manage time, prioritize coding-related tasks, and utilize available resources to meet internal and external deadlines in a dynamic environment.

Required Skills & Experience:

• Education: Bachelor's degree in Health Information Management, Healthcare Administration, or a related field.
• Deep Coding Expertise: Minimum 10+ years of hands-on experience in medical coding (ICD-10-CM/PCS, CPT, HCPCS Level II) across various settings (e.g., inpatient, outpatient, professional). Expert-level understanding of official coding guidelines, conventions, and payer-specific requirements.
• Coding 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). Multiple certifications are a plus.
• Revenue Cycle Knowledge: Strong understanding of the end-to-end healthcare revenue cycle and the critical role of accurate coding within it (charge capture, billing, reimbursement, denial management, compliance).
• Training & Education Experience: Proven experience developing and delivering coding training or education materials/sessions.
• Auditing Experience: Proven experience conducting coding audits, analyzing results, and providing feedback/education.
• DHA Experience: Prior experience working within the Defense Health Agency (DHA) environment. Specific knowledge of DHA coding and billing policies, regulations, and unique requirements is essential.
  • Experience with Electronic Health Record (EHR) systems, specifically Oracle/Cerner (ideally including the MHS GENESIS, Patient Accounting Module - CPAM).
  • Experience with coding software/encoder tools, ideally 3M 360 Encompass (Institutional & Professional).
  • Familiarity with billing/claim solutions (e.g., Electronic Claims Clearinghouse like SSI) and claim scrubber edits (e.g., Alpha ii).
  • Proficiency in using data analytics tools/repositories (e.g., Excel, Power BI, Tableau, HealtheAnalytics) to analyze coding data and trends.
• Analytical & Problem-Solving Skills: Ability to analyze complex coding scenarios, interpret data and reports, identify root causes of coding-related issues, and develop effective solutions.
• Communication Skills: Excellent oral, written, and interpersonal skills to communicate complex coding concepts clearly to diverse audiences.
• Teamwork & Adaptability: Ability to succeed in a dynamic team environment, collaborate effectively, and produce high-quality deliverables under tight timeframes.
• MS Office Proficiency: Strong skills in Microsoft Excel, Word, and PowerPoint.