Role Description
The Mid Revenue Cycle Coding Consultant is responsible for performing professional and facility coding, conducting coding and documentation audits, identifying trends and root causes, and delivering targeted education to providers and coding teams. This individual understands the interconnected nature of documentation, coding, charge capture, compliance, and reimbursement. They work collaboratively with clinical, operational, CDI, revenue integrity, and finance teams to improve accuracy, reduce denials, and enhance overall performance.
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Pivot between production coding and audit responsibilities based on client needs and internal priorities.
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Perform accurate, timely facility and professional coding across inpatient, outpatient, observation, surgery, ED, ancillary, and multiβspecialty services, meeting productivity standards (β₯95β97% accuracy).
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Conduct comprehensive coding audits across inpatient, outpatient, observation, surgery, emergency department, ancillary, and/or professional services.
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Review provider documentation for completeness, specificity, and alignment with billed codes.
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Assign appropriate DRG, ICD-10-CM, ICD-10-PCS, E/M, CPT, HCPCS, and modifiers in accordance with official guidelines, client specific policies, and payer guidelines.
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Ensure coding aligns with CMS, AMA, payer-specific policies, and NCCI edits to support clean claims and denials prevention.
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Compare provider selected and coder selected codes when applicable to identify alignment gaps.
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Provide clear, constructive education and feedback to coders and providers.
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Develop and deliver focused education based on auditing findings and trend analysis.
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Partner with RI, CDI, and operational leaders to address workflow or system-related gaps.
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Identify under coding, over coding, missed charges, risk-adjustment and HCC opportunities, compliance risk, and revenue opportunities.
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Document audit findings with clear rationale, applicable guideline references, and recommended actions.
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Provide respectful, constructive feedback to coders, providers, and stakeholders, including navigating difficult conversations when needed.
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Identify trends, root causes, and recurring patterns impacting coding quality and documentation, and translate them into practical education and process recommendations.
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Develop tip sheets, SOPs, job aids, and training tools to promote coding consistency and best practices.
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Deliver targeted data-driven education and coaching based on audit findings and performance gaps.
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Collaborate with Coding, CDI, Revenue Integrity, and Compliance teams to support denial prevention, revenue protection, and accurate quality reporting.
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Serve as a professional representative and brand ambassador of J2 Integrity Solutions, modeling integrity, and client-focused problem solving.
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Roll up your sleeves to assist with the day-to-day support needed. Create internal policies, procedures, and work efforts at J2.
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Other duties as assigned.
Qualifications
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Certification: CCS, CCS-P, CPC, RHIT, RHIA or equivalent required.
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Experience: 7+ years of combined professional and hospital coding experience.
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3+ years of professional coding audit experience strongly preferred.
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Prior experience in a consulting or multi-client environment is a plus.
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Technical Proficiency: Experience with EHR and encoders. Epic preferred.
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Industry Knowledge: Deep understanding of DRG, ICD-10-CM, ICD-10-PCS, CPT, HCPCS, HCC, modifier application, CMS and AMA documentation standards, NCCI edits and payer-specific requirements, and risk adjustment methodologies.
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Skills: Strong written and verbal communication skills, including the ability to deliver feedback clearly and confidently.
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Ability to work independently in a remote environment, manage competing priorities, and pivot between coding production and audit responsibilities based on client needs.
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High degree of accountability, integrity, and follow-through in meeting deadlines and delivering quality work.
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Ability to use data (dashboards, spreadsheets, and metrics) to track trends and outcomes of audits and education.
Benefits
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Opportunity to drive meaningful changes.
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Support diverse clients.
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Be part of a dynamic team of professionals.