Tria Federal (Tria) · 2 weeks ago
Revenue Integrity Coding & Billing Specialist
United States
Full-time
Remote
Senior Level
7+ years expTria Federal delivers digital services and technology solutions that support the health and safety of veterans, service members, and civilians. They are seeking a Revenue Integrity Coding & Billing Specialist to support the Defense Health Agency’s enterprise Revenue Integrity initiatives, providing expertise in coding, charge capture, billing, and revenue cycle analysis.
ConsultingInformation Technology
No H1B
U.S. Citizen Only
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
Qualification
Required
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
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
Preferred
Experience with MHS GENESIS strongly preferred
Hands-on experience with Cerner revenue cycle workflows
Benefits
Top-tier benefits package
Invest in your physical, mental, and financial health and wellness
Company
Tria Federal (Tria)
Tria Federal (Tria) delivers digital services and technology solutions that support the health and safety of veterans, service members and civilians.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2021-09-01Seed
Leadership Team
Tim Borchert
Chief Executive Officer
Murali Mallina
Chief Technology Officer
Recent News
Washington Technology
2025-10-21
2025-10-15
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