Revenue Integrity Charge Specialist

Kodiak Community Health Center•Kodiak, AK

3d•$26 - $34•Remote

About The Position

Leads a revenue integrity program by coordinating with Kodiak Community Health Center (KCHC) leadership, revenue cycle components, and clinical staff to ensure compliance with government, payor, and internal revenue capture regulations and policies. Leads a revenue integrity team that bridges clinical, coding and revenue cycle operations, and ensures workflows that mitigate compliance risk and maximize reimbursement. Creates and provides revenue cycle and charge capture education program for all staff. A. SITE OF EMPLOYMENT: The site of employment may be the main KCHC medical clinic, the KCHC Administrative building or at any other location where KCHC provides services or staff performs work. Staff may also work remotely. B. ESSENTIAL JOB FUNCTIONS: Acts as a member of the KCHC Healthcare Team in the provision of health services to individuals, families, and/or their communities. Works collaboratively with patients and their caregivers-to the extent preferred by each patient, as well as with other members of the KCHC Healthcare Team to accomplish shared goals within and across settings to achieve coordinated, high-quality care while maximizing reimbursement.

Requirements

Education: Bachelor's degree in a work-related discipline/field from an accredited college or university preferred. High school diploma/GED required.
Experience: Three years of progressively responsible directly related work experience.
Licensure/Certification: AAPC or AHIMA coding credential or certification
Plan, organize, supervise, coordinate, direct and participate in a wide variety of advanced administrative and operational activities related to the assigned program
Coordinate activities with other departments, programs and/or outside agencies
Direct and participate in the analysis of a wide variety of highly complex administrative and operational problems and make effective operational and/or procedural recommendations
Develop, administer and interpret policies, guidelines and procedures related to the assigned program area
Plan, schedule and manage projects of varying scale and length
Monitor current and proposed federal, state and local legislation which impact on assigned area of responsibility
Ability to review, analyze and interpret payor payment policies, billing guidelines, and state and federal regulations
Intermediate Excel skills
Experience in deciphering clinical documentation
Ability to provide leadership in problem identification and issue resolution
Ability to apply critical thinking skills to issues and situations
Work as a member of a team as well as be a self-motivator with ability to work independently
Strong conceptual, as well as quantitative and qualitative analytical skills
Communicate effectively both orally and in writing with all levels of staff personnel.
Well-developed, formal presentations skills
Comfort presenting to and interacting with all levels of staff
Possess interpersonal skills that allow ease of communication with all levels of staff
Regular attendance and punctuality is expected and required.
Must be able to read, write, and speak English.
Principles of healthcare revenue operations
Audit and healthcare compliance functions
Coding conventions
Third-party payor rules and regulations
Computer systems, specifically, Epic and related interfaces
Provider credentialing and insurance enrollment
Working knowledge of regulatory requirements pertaining to healthcare operations and their impact on operations
Cultural Competence – Demonstrates complete understanding and responds effectively with sensitivity to special populations served by KCHC.
Team-oriented and able to work collaboratively with staff.
Strong problem-solving and time-management skills.
Ability to work independently in a fast-paced, medical office environment with frequent interruptions, public contact, and occasional crisis situations.
Ability to maintain strict confidentiality with sensitive medical information and foster an ethical work environment.
Ability and willingness to carry out responsibilities in accordance with the organization's policies and applicable laws.

Responsibilities

Ensure all services rendered are accurately captured, coded, and billed by external billing vendors, with a strong focus on FQHC encounter requirements, PPS reimbursement, and wrap payment accuracy.
Monitor charge capture, claim submission, denials, adjustments, and payment posting to prevent revenue leakage and maximize reimbursement under Medicare, Alaska Medicaid, and commercial payors.
Review encounter documentation to ensure compliance with FQHC billing rules, provider eligibility requirements, and CMS guidelines.
Investigate coding errors, missed encounters, sliding fee scale issues, and compliance risks — and take hands-on action to resolve root causes.
Partner closely with external billing companies to improve claim accuracy, denial management, timely filing compliance, and reconciliation of wrap payments.
Reconcile Medicaid and Medicare PPS payments, supplemental payments, and grant-related billing requirements to ensure completeness and accuracy.
Collaborate with clinical leadership, finance, and operations to strengthen workflows, documentation standards, and charge processes that support compliant FQHC billing.
Provide practical, ongoing training to providers and staff on documentation standards, encounter requirements, sliding fee scale application, and revenue cycle best practices.
Partner with the Chief Financial Officer to review payor contracts, encounter rates, and reimbursement methodologies to optimize sustainable revenue.
Monitor CMS, HRSA, and Alaska Medicaid regulatory updates and advise leadership on operational and financial impact.
Lead measurable revenue integrity improvements that enhance compliance, accountability, and financial performance.
Lead projects to improve revenue compliance, efficiencies in the charge capture process, and Charge Description Master (CDM) charge structures.
Participate in cross-functional meetings to provide input on revenue issue resolution and continuous improvement efforts.
Identify revenue cycle knowledge gaps and provide helpful feedback & training where those gaps exist.
Develop revenue integrity training materials and continuing education resources to help KCHC staff improve their skill sets.
Review billing adjustments for accuracy on an ongoing basis.
Monitor/assess current and proposed Centers for Medicare and Medicaid Services (CMS) Alaska Medicaid legislation and regulations to advise KCHC leadership of potential impact to clinic.
Communicate regulatory changes in a timely manner to revenue cycle operations and clinical staff.
Assess revenue cycle activities to ensure compliance with regulatory standards including those of CMS and Alaska Medicaid. Provide feedback and advise on related compliance matters.
Performs other related duties, as assigned, that support the overall mission and vision of Kodiak Community Health Center.