Revenue Integrity and Data Specialist

FRC•Fairfax, VA

2d•Hybrid

About The Position

Fairfax Radiology Centers (FRC) is seeking an analytical, detail-oriented, and solutions-driven Revenue Integrity and Data Specialist to join its Revenue Cycle team. The role focuses on identifying reimbursement discrepancies, analyzing financial and revenue cycle trends, evaluating external billing vendor performance, and finding ways to protect revenue and improve processes. The position uses data analysis and investigation to support financial accuracy, operational efficiency, and patient care. The specialist conducts audits and analyses, investigates billing, payer, system, and workflow issues, and develops monitoring tools and internal controls. The role also supports external billing vendors, analyzes accounts receivable and reimbursement, maintains fee schedules and insurance profiles, assists with revenue cycle technology and process changes, and collaborates with internal teams and external partners. The position is hybrid, initially requiring on-site work one to two days per week, with potential for increased remote flexibility based on departmental needs. This is an internal posting for current FRC employees only.

Requirements

Bachelor's degree in Healthcare Administration, Health Sciences, Finance, or a related field, and at least three years of healthcare revenue cycle experience involving reimbursement analysis, denials, accounts receivable, revenue integrity, or billing performance analysis; an equivalent combination of education and experience will be considered.
Advanced Microsoft Excel skills, including PivotTables, XLOOKUP/VLOOKUP or comparable lookup functions, formulas, data reconciliation, data validation, and analysis of large datasets.
Experience developing and analyzing reports, dashboards, and key performance indicators using Power BI or comparable business intelligence and reporting tools.
Working knowledge of healthcare revenue cycle systems, medical billing workflows, insurance payer requirements, and reimbursement processes.
Experience researching and resolving complex billing discrepancies, reimbursement variances, and payment issues.
Strong analytical, critical-thinking, problem-solving, and organizational skills.
Ability to communicate findings and collaborate effectively with internal and external partners.

Nice To Haves

Professional certification in healthcare billing, coding, reimbursement, or revenue cycle, such as CPC, CRCR, CBCS, CRCS, or a comparable certification.
Experience conducting revenue integrity audits, identifying revenue leakage, or analyzing underpayments.
Experience evaluating external billing vendor performance and revenue cycle KPIs.
Familiarity with system testing, workflow development, data validation, or revenue cycle technology implementations.

Responsibilities

Conduct revenue integrity and underpayment audits to identify reimbursement discrepancies, inappropriate adjustments, billing inaccuracies, and potential revenue leakage.
Analyze reimbursement trends, denial patterns, contractual allowances, write-offs, and other revenue cycle data to identify opportunities for improvement.
Review and validate reports, dashboards, and financial data; investigate discrepancies; quantify the financial impact of issues; and recommend corrective actions.
Develop targeted analyses, monitoring tools, and internal controls to strengthen revenue integrity and prevent recurring issues.
Monitor corrective actions to ensure problems are resolved and improvements are sustained.
Evaluate external billing vendor performance using key performance indicators, account reviews, reporting, and reimbursement trends.
Analyze vendor-processed accounts for billing accuracy, payment performance, denials, adjustments, and account resolution.
Research complex vendor inquiries involving reimbursement variances, payer configuration, denials, and billing discrepancies.
Participate in vendor meetings, present analytical findings, collaborate on performance improvements, and provide billing partners with guidance on organizational processes, payer requirements, and operational workflows.
Use advanced Excel, Power BI or comparable reporting tools, and revenue cycle systems to analyze large datasets and identify trends.
Investigate system, interface, and workflow issues affecting billing accuracy, reimbursement, or reporting.
Support system upgrades, testing, data validation, configuration changes, and implementation of new revenue cycle technology.
Participate in future EMR/EHR implementations to support accurate workflows, data integrity, and operational readiness.
Maintain accurate fee schedules and insurance profiles to support revenue cycle operations and patient cost estimates.
Identify opportunities to streamline processes, strengthen internal controls, improve reporting, and introduce efficiencies.
Analyze legacy accounts receivable to identify outstanding balances, denials, underpayments, and opportunities for account resolution.
Research and resolve complex payer issues, including appropriate follow-up and escalation.
Perform reimbursement analyses and financial modeling to support managed care activities, payer escalations, and contract-related matters.
Validate reimbursement accuracy following payer corrections, contract changes, or system updates.
Support initiatives to resolve outstanding accounts and reduce revenue risk.
Provide timely internal support, including to Hospitality Associates, on insurance coverage, payer participation, and reimbursement questions through Microsoft Teams and telephone.
Research and resolve complex billing, payer, and revenue cycle questions requiring detailed investigation.
Collaborate with internal departments and external partners on special billing arrangements, pricing analyses, and reimbursement-related projects.
Participate in cross-functional initiatives to improve revenue cycle accuracy, efficiency, and performance.