Revenue Integrity Coding & Billing Specialist

Tria Federal is seeking a Revenue Integrity Coding & Billing Specialist to support the Defense Health Agency’s (DHA) enterprise Revenue Integrity (RI) initiatives. This role provides advanced subject matter expertise in coding, charge capture, billing, and revenue cycle analysis to support compliant, accurate, and timely revenue capture across the Military Health System (MHS). The Specialist operates at an enterprise level, leveraging DHA revenue cycle data to identify risk, resolve complex claim issues, and drive systemic revenue integrity improvements across multiple Military Treatment Facilities (MTFs) and service lines.
**This opportunity is contingent upon award.**

Responsibilities:

• Serve as a coding, billing, and revenue integrity subject matter expert supporting enterprise RI initiatives across inpatient, outpatient, professional, emergency, and procedural services.
• Perform advanced review and validation of ICD-10-CM, CPT, and HCPCS coding to ensure alignment with clinical documentation, medical necessity, and enterprise billing requirements.
• Pull, analyze, and interpret DHA revenue cycle data to identify coding, charge capture, billing, and denial risks impacting enterprise revenue.
• Analyze and resolve complex coding- and billing-related claim edits, pre-bill holds, and suspended charges within MHS GENESIS and downstream billing systems.
• Utilize DHA and MHS data sources (e.g., HealtheAnalytics, HDI/HARC, MHS GENESIS reporting, Alpha II, SSI, M2, MDR, EAS IV, or similar repositories) to assess edit trends, denial drivers, DNFB exposure, and financial impact.
• Evaluate charge capture workflows using data-driven methods to confirm services are accurately generated, mapped, priced, and transmitted across the full revenue lifecycle.
• Investigate and resolve high-risk, high-dollar, or recurring denials related to coding accuracy, modifier usage, medical necessity, or billing logic.
• Identify systemic trends and root causes in coding errors, charge defects, and billing failures, and develop enterprise-level remediation and prevention recommendations.
• Collaborate with Revenue Integrity leadership, medical coding programs, patient accounting teams, clinical stakeholders, and system solution owners to coordinate cross-functional resolution of enterprise issues.
• Interpret and apply Official Coding Guidelines, TRICARE policy, NCCI edits, LCD/NCDs, and DHA billing guidance to complex enterprise scenarios.
• Support revenue integrity reviews, focused audits, and compliance activities by providing data-backed analysis, documentation, and defensible rationale.
• Contribute to the development of enterprise coding and billing guidance, playbooks, dashboards, and targeted education for DHA and MTF stakeholders.
• Prepare and present enterprise-level reporting and analysis on claim edits, denial trends, financial exposure, and revenue integrity outcomes.

Required Skills & Experience:

• Active coding certification from AHIMA or AAPC (e.g., CCS, CCS-P, CPC, COC, CIC) required.
• 7+ years of progressive medical coding and billing experience, including substantial involvement in enterprise revenue integrity, denial management, or claim edit resolution.
• Expert knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and payer edit logic, including NCCI, LCD/NCD, and medical necessity requirements.
• Demonstrated experience pulling, analyzing, and interpreting revenue cycle data to support decision-making, root cause analysis, and revenue integrity initiatives.
• Experience supporting enterprise or multi-facility revenue cycle operations, preferably within DHA, DoD, VA, or a large integrated health system.
• Hands-on experience with Cerner revenue cycle workflows; experience with MHS GENESIS strongly preferred.
• Working knowledge of DHA/MHS revenue cycle data repositories and reporting tools (e.g., HealtheAnalytics, HDI/HARC, Alpha II, SSI, M2, MDR, EAS IV).
• Strong understanding of end-to-end revenue cycle processes, including charge capture, billing, accounts receivable, denials, and compliance controls.
• Proven ability to analyze payer remittances, EOBs, denial codes, and upstream data sources to identify systemic issues.
• Advanced analytical and documentation skills, with the ability to translate data findings into actionable, enterprise-level recommendations.
• Proficiency with Microsoft Excel (pivot tables, data analysis) and PowerPoint for executive-level communication.
• Excellent written and verbal communication skills, including experience briefing senior and cross-functional stakeholders.
• Ability to obtain and maintain a Public Trust clearance.