RCMI Senior Solution Technical Expert (SSTE), Revenue Integrity Coding & Billing

Описание вакансии

Great Hill Solutions, LLCis part of the Seneca Nation Group (SNG) portfolio of companies. SNGis Seneca Holdings' 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. To learn more about SNG, visit the website and follow us on LinkedIn.

Our team of talented individuals is what makes us successful. To support our team, we provide a balanced mix of benefits and programs. Your total rewards package includes competitive pay, benefits, and perks, flexible work-life balance, professional development opportunities, and performance and recognition programs. We offer a comprehensive benefits package that includes medical, dental, vision, life, and disability, voluntary benefit programs (critical illness, hospital, and accident), health savings and flexible spending accounts, and retirement 401K plan. One of our fundamental principles is to offer competitive health and welfare benefits to our team members, providing coverage and care for you and your family. Full-time employees working at least 30 hours a week on a regular basis are eligible to participate in our benefits and paid leave programs. We pride ourselves on our collaborative 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 Solutionsis seeking a Revenue Cycle Modernization & Innovation Senior Solution Technical Expert, Revenue Integrity Coding & Billing in the continental United States, remote authorized, to support the Defense Health Agency. The Senior Solution Technical Expert, Revenue Integrity Coding & Billing provides enterprise level subject matter expertise in coding, charge capture, billing, denial management, and revenue integrity analytics across the Military Health System. This role supports development, implementation, and sustainment of enterprise Revenue Integrity initiatives within MHS GENESIS and associated DHA data platforms to ensure compliant, accurate, and timely revenue capture across multiple Military Treatment Facilities and service lines.

Roles and Responsibilities include but are not limited to:

• Serve as an enterprise coding, billing, and revenue integrity subject matter expert supporting inpatient, outpatient, professional, emergency, ancillary, and procedural services.
• Perform 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 complex claim edits, pre bill holds, DNFB exposure, and suspended charges within MHS GENESIS and downstream billing systems.
• Pull, reconcile, and interpret DHA revenue cycle data from sources such as HealtheAnalytics, HDI, HARC, MHS GENESIS reporting, Alpha II, SSI, M2, MDR, EAS IV, or similar repositories to identify coding, billing, and denial risks.
• Evaluate charge capture workflows using data driven methods to confirm services are generated, mapped, priced, and transmitted accurately across the end to end revenue lifecycle.
• Investigate high risk, high dollar, or recurring denials related to coding accuracy, modifier usage, medical necessity, bundling, or billing logic and coordinate enterprise level remediation.
• Identify systemic trends and root causes in coding defects, charge variances, billing failures, and reimbursement discrepancies and develop corrective and preventive action recommendations.
• Support chart to bill reviews, focused audits, compliance assessments, and audit readiness activities by providing defensible documentation and data backed analysis.
• Collaborate with Revenue Integrity leadership, coding programs, patient accounting teams, UBO, clinical stakeholders, and system solution owners to coordinate cross functional issue resolution.
• Contribute to development of enterprise 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 outcomes.
• Support configuration validation and workflow optimization within Oracle Health Cerner MHS GENESIS to reduce revenue leakage and improve compliance.
• Participate in working groups, governance forums, and enterprise initiatives aligned to Revenue Cycle Modernization and Innovation objectives.

Basic Requirements:

• Bachelor’s degree in a clinical, healthcare, business, or related field. An Associate’s degree combined with an additional five years of revenue 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 Public Trust clearance.
• Due to government contract requirements, United States citizenship is required.
• Active coding certification from AHIMA or AAPC such as CCS, CCS P, CPC, COC, CIC, or equivalent.
• Five or more years of progressive medical coding and billing experience, including significant involvement in revenue integrity, denial management, claim edit resolution, or enterprise revenue 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 revenue cycle data to support root cause analysis and enterprise level decision making.
• Strong proficiency in Microsoft Excel 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 enterprise or multi facility revenue cycle operations within the Defense Health Agency, Military Health System, Department of Defense, Veterans Affairs, or a large integrated health system.
• Hands on experience with Oracle Health Cerner revenue cycle workflows, with MHS GENESIS experience strongly preferred.
• Working knowledge of DHA and MHS revenue cycle data repositories and reporting tools including HealtheAnalytics, HDI, HARC, Alpha 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 enterprise internal control activities.
• Demonstrated ability to translate analytic findings into actionable enterprise level remediation strategies.
• Professional 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 enterprise priorities.

Equal Opportunity Statement:

Seneca Holdings provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex/gender, sexual orientation, national origin, 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 all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation and training. The Company also prohibits retaliation against any employee who exercises his or her rights under applicable anti-discrimination laws. Notwithstanding the foregoing, the Company does give hiring preference to Seneca or Native individuals. Veterans with expertise in these areas are highly encouraged to apply.