Revenue Integrity Specialist
About The Position
The Revenue Integrity Specialist supports revenue optimization, regulatory compliance, and charge capture integrity across the enterprise. The role collaborates with clinical departments, Revenue Cycle, Health Information Management, Health Information Technology, and other stakeholders. It performs advanced edits, validations, and analytical reviews, applying judgment to identify trends, resolve complex issues, and support accurate reimbursement and sustainable revenue practices. The position is in the Revenue Cycle Management department at UAB St. Vincent's Birmingham, with a Monday-through-Friday schedule and an opportunity for remote work. The specialist ensures accurate CPT/HCPCS documentation and appropriate coding for patient billing, supports charge capture in assigned areas, and performs coding, documentation, and claim-denial reviews. The role also works pre-bill edits, provides hands-on support to ancillary departments, reviews and approves charges, and helps ensure documentation and charges align with applicable coding guidelines. It educates clinical staff, analyzes clinical and billing trends, and works with department leadership and care sites to improve revenue-cycle performance and ensure charges are documented, captured, and reconciled.
Requirements
- Bachelor’s degree in Finance, Accounting, Management, or a hospital-related field.
- At least three years of experience in billing, charge documentation, charge audit, charge capture, or other revenue-cycle-related functions.
- A coding credential is required: RHIA, RHIT, CCS, CPC/COC/CIC, AAPC, or another coding credential.
Nice To Haves
- HFMA Certified Revenue Cycle Specialist (CRCS) certification is preferred.
Responsibilities
- Ensure accurate CPT/HCPCS documentation for patient billing and educate colleagues and ancillary departments on documenting services and using appropriate codes.
- Support charge capture in assigned Revenue Integrity areas, where applicable; perform CPT coding, documentation reviews, and claim-denial reviews, and ensure charges and coding align with AMA and Medicare guidelines.
- Work pre-bill edits within key metrics, including OCE/CCI and DNFB.
- Provide at-elbow support to ancillary departments, including checking supply and implant charge capture, identifying duplicate charges, and communicating documentation or charge deficiencies and errors.
- Perform charge entry, charge approvals, and quality charge reviews, including appending modifiers and checking clinical documentation; provide feedback to Revenue Integrity colleagues about improvement opportunities.
- Code or validate charges for complex service lines, with advanced proficiency in surgical or specialty coding.
- Educate clinical staff about complete and accurate documentation for revenue optimization and integrity; provide consultation and training on charge protocols, charge sheets or screens, and processes for capturing daily charges.
- Provide ongoing feedback and analyze trends in clinical and billing data to identify documentation, coding, and charging issues.
- Work with clinical areas to support accurate documentation and understanding of the relationship among documentation, medical necessity, coding, and charging.
- Identify trends and collaborate with leadership to improve revenue-cycle performance within hospitals and/or ambulatory clinics.
- Collaborate with revenue-producing department leadership and clinical care sites to ensure charges are documented, captured, and reconciled.
Benefits
- Generous paid time off (for eligible positions).
- Paid parental leave (for eligible positions).
- Associate Assistance Program (for eligible positions).
- Tuition Reimbursement Program (for eligible positions).
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
