Revenue Integrity Review Specialist

Waystar

1d

About The Position

The Revenue Integrity Review Specialist conducts high-quality medical record reviews for Waystar customers. The role applies advanced coding and Clinical Documentation Integrity (CDI) expertise to identify documentation, coding, quality, and reimbursement opportunities while ensuring compliance with industry standards and regulatory requirements. The specialist is expected to deliver efficient, clinically supported, accurate, and compliant review outcomes that align with customer expectations in a production-based review environment.

The position includes reviewing records, evaluating documentation accuracy and code assignment, identifying opportunities for clarification, and developing compliant physician queries when needed. The specialist must maintain current knowledge of coding, CDI, reimbursement methodologies, clinical practice standards, and relevant regulatory changes, while meeting established productivity, quality, accuracy, and turnaround-time standards.

Requirements

• BSN, RHIA, RHIT, CCS, CCDS, CDIP, or equivalent healthcare credentials.
• 3–5 years of experience in inpatient coding, CDI, revenue integrity, auditing, or a related healthcare field.
• Strong knowledge of ICD-10-CM/PCS coding guidelines, CDI practices, MS-DRG assignment, clinical validation, and physician query best practices.
• Demonstrated ability to achieve productivity, quality, and accuracy standards in a high-volume review environment.
• Strong analytical, critical thinking, and communication skills, with the ability to work independently and manage competing priorities.

Nice To Haves

• Dual certification (CCDS/CDIP and CCS) or willingness to obtain additional certification.
• Experience reviewing records within healthcare technology platforms, such as Prebill or similar clinical review solutions.

Responsibilities

• Conduct comprehensive medical record reviews to identify coding, CDI, quality, and revenue integrity opportunities.
• Apply knowledge of ICD-10-CM, ICD-10-PCS, MS-DRG methodology, CDI principles, and clinical validation concepts to evaluate documentation accuracy, code assignment, and clinical support.
• Identify documentation accuracy opportunities and develop compliant physician queries when clarification is needed.
• Ensure review findings and recommendations are accurate, clinically supported, compliant, and aligned with Official Coding Guidelines, AHIMA/ACDIS Query Practice Briefs, regulatory requirements, and customer-specific standards.
• Meet established productivity, quality, accuracy, and turnaround-time standards while managing a high volume of reviews.
• Prioritize workload effectively and work independently in a fast-paced production environment.
• Maintain current knowledge of coding, CDI, reimbursement methodologies, clinical practice standards, and regulatory changes affecting review outcomes.
• Deliver review results that meet customer expectations and organizational performance standards.

Benefits

• Competitive total rewards, including base salary and bonus if applicable.
• Customizable benefits package with three medical plans and a company Health Savings Account match.
• Paid time off for non-exempt team members, starting with three weeks, plus 13 paid holidays including two personal floating holidays.
• Flexible time off for exempt team members, plus 13 paid holidays.
• Paid parental leave, including maternity and paternity leave.
• Education assistance opportunities and free LinkedIn Learning access.
• Free mental health and family planning programs, including adoption assistance and fertility support.
• 401(k) program with company match.
• Pet insurance.
• Employee resource groups.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level