Revenue Integrity Specialist

Lifepoint Health • Beckley, WV

2d • Onsite

About The Position

The Revenue Integrity Specialist plays a key role in protecting and optimizing hospital reimbursement by identifying revenue opportunities, resolving billing and payer issues, and managing denials, audits, and appeals. This role partners across clinical and revenue-cycle teams to improve processes, ensure billing and regulatory compliance, and strengthen the organization’s ability to capture all reimbursement to which it is entitled. As the Revenue Integrity Specialist joining our team, you’re embracing a vital mission dedicated to making communities healthier. At Raleigh General Hospital people are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. We offer a wide range of surgical services as well as specialty programs including Cardiac CTA, Digital Mammography, and Trauma Services.

Requirements

• High school diploma or equivalent required.
• Strong knowledge of patient accounting, hospital bill processing, insurance practices, billing systems, and their uses, capabilities, and limitations.
• Demonstrated knowledge of CPT/HCPCS, diagnosis and revenue codes, UB-04, modifiers, Medicare APCs, and other hospital coding and billing requirements.
• Working knowledge of Medicare IPPS and OPPS, Medicaid, commercial payer guidelines, and applicable billing and reimbursement regulations.
• Strong understanding of hospital charging, rate structures, reimbursement methodologies, and the ability to analyze reimbursement and identify opportunities or issues.
• Ability to research and resolve complex revenue-cycle issues, analyze information, identify root causes, and clearly articulate audit and reimbursement findings.
• Strong written and verbal communication skills, proficiency with Excel and other computer-based systems, strong organizational and multitasking abilities, and the ability to work effectively with internal and external customers.
• Self-starter who is willing to learn new responsibilities, adapt to changing priorities, manage multiple tasks, and perform effectively with minimal supervision.

Nice To Haves

• College education or at least two years of relevant experience preferred.
• Two years of hospital revenue cycle experience preferred; physician billing and reimbursement experience is a plus.

Responsibilities

• Coordinate, evaluate, and measure revenue integrity operations to identify opportunities that improve reimbursement, reduce revenue leakage, and strengthen overall revenue-cycle performance.
• Coordinate RAC and payer audit requests, maintain tracking systems, manage documentation and submission timelines, and support denial and appeal resolution.
• Develop and maintain tracking mechanisms to identify loss leaders, denial trends, reimbursement opportunities, and improvements by service line, payer, and provider.
• Perform or support medical necessity reviews, verify insurance benefits, obtain required authorizations and precertifications, and identify issues that may impact reimbursement.
• Partner with operational and clinical teams to support accurate charging, coding, claim submission, and reimbursement while maintaining compliance with CPT/HCPCS, UB-04, modifiers, Medicare APCs, payer requirements, and applicable regulations.
• Collaborate with Scheduling, Registration, Clinical Departments, HIM, Managed Care & Reimbursement, Supply Chain, and Business Office teams to identify root causes and implement sustainable revenue-cycle improvements.
• Develop educational materials, communicate audit and denial findings, and provide training and competency support to staff whose activities impact revenue integrity and clean claims.
• Assist with SOX audits, insurance denial appeals, government correspondence, policy and procedure development, and regulatory monitoring while identifying opportunities to prevent recurring revenue-cycle issues.

Benefits

• Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs)
• Ongoing learning and career advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED