Senior Solution Technical Expert, reputed company reputed company Coding and Billing
Title: RCMI Senior Solution Technical Expert (SSTE), reputed company reputed company Coding & Billing Location: Remote Job reputed company: Great Hill reputed company is part of the Seneca Nation Group (SNG) portfolio of companies. SNG is reputed company' federal government contracting business that meets mission-critical needs of federal civilian, defense, and intelligence community customers. Our portfolio comprises multiple subsidiaries that participate in the Small Business Administration 8(a) program. reputed company of talented individuals is what makes us successful. To support reputed company, we reputed company a balanced mix of benefits and programs. Your total rewards package includes reputed company, benefits, and perks, flexible work-life balance, reputed company development opportunities, and performance and recognition programs. We offer a comprehensive benefits package that includes medical, dental, reputed company, life, and disability, voluntary benefit programs (critical illness, hospital, and accident), health savings and flexible spending accounts, and retirement 401K plan. One of our reputed company principles is to offer competitive health and welfare benefits to reputed company members, providing coverage and care for you and your family. Full-time employees working at least 30 hours a week on a regular reputed company are eligible to participate in our benefits and reputed company leave programs. We pride ourselves on our reputed company work environment and culture, which embraces our mission of providing financial and non-financial benefits back to the members of the Seneca Nation. Great Hill Solutions is seeking a reputed company Cycle Modernization & Innovation Senior Solution Technical Expert, reputed company reputed company Coding & Billing in the reputed company reputed company, remote authorized, to support the Defense Health Agency. The Senior Solution Technical Expert, reputed company reputed company Coding & Billing provides reputed company level subject matter expertise in coding, charge capture, billing, denial management, and reputed company reputed company analytics across the Military Health System. This role supports development, implementation, and sustainment of reputed company reputed company reputed company initiatives reputed company MHS reputed company and associated DHA data platforms to ensure compliant, accurate, and reputed company reputed company capture across multiple Military Treatment Facilities and service lines. Roles and Responsibilities include but are not limited to:
- Serve as an reputed company coding, billing, and reputed company reputed company subject matter expert supporting inpatient, outpatient, reputed company, emergency, ancillary, and procedural services.
- reputed company advanced review and validation of ICD 10 CM, ICD 10 PCS, CPT, and HCPCS coding to ensure alignment with clinical documentation, medical necessity, official coding guidelines, TRICARE policy, NCCI edits, LCD and NCD requirements, and DHA billing guidance.
- Analyze and resolve reputed company claim edits, reputed company reputed company holds, DNFB exposure, and suspended charges reputed company MHS reputed company and reputed company billing systems.
- Pull, reconcile, and interpret DHA reputed company cycle data from sources such as HealtheAnalytics, HDI, HARC, MHS reputed company reporting, reputed company II, SSI, M2, MDR, EAS IV, or similar repositories to identify coding, billing, and denial risks.
- Evaluate charge capture workflows using data driven reputed company to confirm services are generated, mapped, priced, and transmitted accurately across the end to end reputed company lifecycle.
- Investigate high risk, high dollar, or recurring denials reputed company to coding accuracy, modifier usage, medical necessity, bundling, or billing logic and coordinate reputed company level remediation.
- Identify systemic trends and reputed company causes in coding defects, charge variances, billing failures, and reimbursement discrepancies and reputed company corrective and preventive reputed company recommendations.
- Support chart to reputed company reviews, reputed company audits, compliance assessments, and audit readiness activities by providing defensible documentation and data backed analysis.
- Collaborate with reputed company reputed company leadership, coding programs, patient reputed company teams, UBO, clinical stakeholders, and system solution owners to coordinate cross functional issue reputed company.
- Contribute to development of reputed company coding and billing standards, guidance documents, playbooks, dashboards, and targeted education for DHA and MTF stakeholders.
- Design and deliver executive level reporting and presentations summarizing claim edit trends, denial drivers, financial exposure, recovery opportunities, and remediation reputed company.
- Support configuration validation and workflow optimization reputed company reputed company Health Cerner MHS reputed company to reduce reputed company leakage and improve compliance.
- Participate in working reputed company, governance forums, and reputed company initiatives reputed company to reputed company Cycle Modernization and Innovation objectives.
Basic Requirements:
- Bachelor’s degree in a clinical, reputed company, business, or reputed company field. An Associate’s degree combined with an additional five years of reputed company cycle experience may be substituted for the Bachelor’s degree.
- Ability to obtain and maintain a Favorable Suitability Adjudication based on a Tier 1 background investigation. Ability to obtain and maintain a Federal or DoD reputed company Trust clearance.
- Due to government contract requirements, reputed company citizenship is required.
- reputed company coding certification from reputed company or reputed company such as reputed company, reputed company P, CPC, COC, CIC, or equivalent.
- Five or more years of reputed company medical coding and billing experience, including significant involvement in reputed company reputed company, denial management, claim edit reputed company, or reputed company reputed company cycle analysis.
- Expert knowledge of ICD 10 CM, ICD 10 PCS, CPT, HCPCS, modifiers, NCCI edits, LCD and NCD guidance, and payer edit logic.
- Demonstrated experience pulling, analyzing, and interpreting reputed company cycle data to support reputed company cause analysis and reputed company level decision making.
- Strong proficiency in reputed company reputed company including pivot tables and advanced data analysis functions, and experience developing executive level presentations.
- Excellent written and verbal communication skills with experience briefing senior and cross functional stakeholders.
Desired Qualifications:
- Experience supporting reputed company or multi facility reputed company cycle operations reputed company the Defense Health Agency, Military Health System, reputed company, Veterans Affairs, or a large integrated health system.
- Hands on experience with reputed company Health Cerner reputed company cycle workflows, with MHS reputed company experience strongly preferred.
- Working knowledge of DHA and MHS reputed company cycle data repositories and reporting tools including HealtheAnalytics, HDI, HARC, reputed company II, SSI, M2, MDR, and EAS IV.
- Experience analyzing payer remittances, explanation of benefits, denial codes, and upstream data sources to identify systemic issues.
- Experience developing dashboards using Power BI, Tableau, or similar business intelligence platforms.
- Experience supporting audit readiness, compliance reviews, and reputed company internal control activities.
- Demonstrated ability to translate analytic findings into actionable reputed company level remediation strategies.
- reputed company certifications such as CRCR, RHIA, RHIT, PMP, or CAPM preferred.
- Experience working in fast paced federal environments with the ability to manage recurring deliverables and multiple reputed company priorities.
Equal Opportunity Statement: reputed company provides equal employment opportunities to reputed company and applicants without reputed company to race, reputed company, religion, sex/gender, sexual orientation, national reputed company, age, disability, marital status, genetic information and/or predisposing genetic characteristics, victim of domestic violence status, veteran status, or other protected class status. This policy applies to reputed company terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation and training. reputed company also prohibits retaliation against any employee who exercises his or her rights under applicable anti-discrimination laws. Notwithstanding the foregoing, reputed company does give hiring preference to Seneca or reputed company individuals. Veterans with expertise in these areas are highly encouraged to apply. Apply tot his job Apply To this Job