Revenue Integrity Coding Specialist

LifeStance Health

1d•$28 - $33•Remote

About The Position

We are seeking a certified Revenue Integrity Coding Specialist to join our Shared Services team, supporting Revenue Cycle Management (RCM) and driving financial performance. The ideal candidate will have a strong working knowledge of CPT rules, ICD-10 guidelines, and payor reimbursement policies. This role involves practice pattern monitoring, claim scrubbing and payor audit management. The Revenue Integrity Coding Specialist will support revenue cycle with post-payment audits, pre-payment reviews, and claim-line rebuttals to dispute recoupment. Emphasis is placed on preventative process measures for denial prevention, including claim scrubbing, detecting error trends, and working with stakeholders to solve root causes. We are a collaborative and supportive team with weekly touchpoints and professional development opportunities. Our data-driven approach makes us a great match for Revenue Integrity Coding Specialists interested in data analysis. This role reports to the Sr. Manager, Revenue Integrity. This mission-driven role is crucial in ensuring access to quality mental health care by removing barriers for patients utilizing their healthcare benefits. By managing and executing non-clinical functions, this position allows clinicians to focus on providing exceptional patient care. Consistent with LifeStance’s values, every member of the LifeStance team is expected to support each other and the mission, which may mean participating in projects and initiatives and performing functions and responsibilities not specifically outlined in this job description. This position is a remote role with the ability to sit within any US locality. Compensation: $27.50- $33.00 Hourly with potential bonus

Requirements

Passed a Medical Coding Certificate Exam (CPC, CPC-A, CCS, CPMA) or at least 4 years' experience coaching clinical coding and applying clinical coding in a healthcare setting, demonstrating a proficiency in medical terminology
Advanced knowledge of Payor Audits, Rebuttals, and Redeterminations.
Advanced Microsoft Excel, with heavy use of data analysis and proficiency in Microsoft Word.
Experience with Electronic Medical Records, Practice Management Software, and HIPAA requirements.
Strong verbal and written communication skills are important.
Flexibility, creativity, and empathy to balance priorities and maintain good relationships within the team and with stakeholders.
Proven ability to lead through organizational change.

Nice To Haves

Medical Coding Certificate (CPC, CPC-A, CCS) preferred.
Comparable certification and/or degree may be considered in lieu of Medical Coding Certification.
Knowledge of mental/behavioral health is desired.
Adaptability: Ability to navigate and thrive in situations with unclear or evolving requirements.
Bias for Action: Proactive approach to problem-solving and willingness to take initiative.
Team Player: Strong collaboration skills and a positive attitude towards working with team members.
Engagement: Active participation in team activities and a commitment to contributing to a supportive and inclusive work environment.

Responsibilities

Support high-value projects to move the business forward with its strategic goals.
Improve Days Sales Outstanding (DSO) and Denial Rate through prompt troubleshooting.
Respond to external charge code audits and improve payor audit resolution rates
Problem solves correctable coding errors reducing denials and revenue leakage
Research payer reimbursement guidelines and evaluates impact to coding practices
Leverage an advanced machine learning tool, for proactive detection of trends monitored by health plans
Identify exceptions and outliers, validate the machine learning output with manual review.
Use PowerBI and Advanced Excel to identify and confirm trends
Notify state Medical and Clinical Leaders of opportunities to support documentation improvement for payer audits.
Evaluate data and partner with Revenue Cycle Leader to enhance upstream intervention and downstream response to coding related denials and exclusions
Execute the Coding Informatics Payer Audit Standardization initiative.
Liaise between internal departments and external vendors to align on standard operating procedures for successful medical records submission.
Monitor trends in payer audits to enhance workflows and processes.
Maintain clear and accurate departmental documents and procedures.
Track and monitor the success of various payer audits.
Track company performance on payer audits and recoupments.
Provide monthly scorecards to the Sr Director and communicate progress toward personal performance objectives.
Execute strategies to improve efficiency, customer satisfaction, and operational effectiveness.
Identify inefficiencies in workflows and implement solutions to enhance productivity, quality, and operational efficiency.