Documentation and Revenue Specialist

The Documentation and Revenue Operations Specialist play a critical role in supporting providers by ensuring accurate and compliant clinical documentation and coding across both hospital-based (HB) and professional billing (PB) settings. This individual will reconcile daily charges, educate clinical staff, collaborate with Revenue Integrity and Compliance, and optimize workflows to support accurate reimbursement and operational efficiency.

1. Documentation & Provider Support

* Partner with providers to ensure documentation supports accurate code selection and billing.

* Assist with real-time or retrospective review of documentation, identify gaps, and suggest improvement strategies.

* Educate providers on coding updates, payer policies, and documentation best practices.

2. Coding & Charge Reconciliation

* Apply comprehensive knowledge of CPT, ICD-10, and E/M guidelines specific to OB/GYN services.

* Review, edit, and reconcile daily charges to ensure accuracy and compliance before submission.

* Verify that charges are correctly assigned to the appropriate HAR and encounter.

3. Operational Integration

* Navigate workflows across both hospital and clinic environments to enable seamless documentation and billing.

* Collaborate with clinical, scheduling, and front office teams to ensure operational alignment and efficiency.

* Assist in developing processes to enhance coding and documentation workflows.

4. Revenue Integrity & Compliance

* Partner with Revenue Integrity to identify trends, resolve coding and billing discrepancies, and ensure correct HB and PB submissions.

* Assist in internal audits and implement corrective action plans.

* Stay current on federal and state regulations, payer requirements, and organizational policies.

5. Training & Education

* Provide education and support to both new and existing clinical and administrative staff on charge capture, coding updates, and documentation requirements.

* Engage in ongoing coding training to maintain certification and stay informed about current regulations

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. Associate's degree in a healthcare-related field required; Bachelor's degree preferred. Equivalent work experience may substitute for the degree requirement.

Experience:

Minimum of 1-2 years of professional/physician or outpatient coding experience preferred.

Minimum of 2 years of experience in a clinical setting.

Experience in both hospital-based (HB) and professional billing (PB) coding environments preferred.

Strong working knowledge of healthcare billing regulations, coding compliance guidelines, and reimbursement practices.

Proficiency in EHR systems, with Epic preferred; familiarity with daily reconciliation workflows.

Excellent communication, organizational, and problem-solving skills.

License(s):

None

Certification(s):

Ability to obtain Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT), or equivalent certification within 1 year of employment.

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.