Revenue Integrity Specialist

Seattle Children's•Washington, DC

9d•$91,010 - $136,514•Remote

About The Position

This role involves researching and analyzing coding-related denials and revenue flow interruptions to identify patterns of payer behavior, coder trends, or system issues. The specialist will maintain denial work queues, perform hands-on remediation, track escalations, and communicate with Payer Relations and Hospital Billing teams. They will also serve as a strategic partner to assigned service lines by providing revenue-related reporting (SlicerDicer, Reporting Workbench) and assisting operational owners with charge reconciliation understanding. Additionally, the specialist will be a subject matter expert on facility payment models (DRG, APC, EAPG) and technical charge flow through Epic for both inpatient and outpatient services. A key aspect of the role is identifying opportunities for automation and AI implementation to improve compliant revenue capture, and collaborating with coding educators and service line leaders to bridge gaps between clinical and revenue cycle processes.

Requirements

Associate degree in Health Information Management or related field or equivalent relevant work experience.
Minimum of five years of experience in coding and abstracting clinical information in an acute care hospital setting or equivalent, including direct experience with both facility and professional coding practices and standards.
Minimum one year of experience in a Revenue Integrity-related role (e.g., denial management, charge capture analysis, revenue cycle auditing).
Certified Coding Specialist (CCS) certification by the American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC).
Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) willing to obtain coding credential (listed above) within 6 months of hire.

Nice To Haves

Bachelor’s degree.
Experience in an Academic acute care setting.
Experience in a Pediatric acute care setting.
Experience with EPIC.
Experience with SharePoint and instructional design.
Experience in coding denial management and appeals process.
Experience in research of payer policy and coding guidelines.
Experience with decision support systems.
Experience with encoders (3M).
Adept at use of Excel, Word, PowerPoint.

Responsibilities

Research and analyze coding-related denials and revenue flow interruptions to identify patterns of payer behavior, coder trends, or system issues.
Maintain denial work queues and perform hands-on remediation, escalation tracking, and communication with Payer Relations and Hospital Billing teams.
Act as a strategic partner to assigned service lines by providing revenue-related reporting (SlicerDicer, Reporting Workbench) and assisting operational owners with charge reconciliation understanding.
Serve as a subject matter expert on facility payment models (DRG, APC, EAPG) and technical charge flow through Epic for both inpatient and outpatient services.
Identify opportunities for automation and AI implementation to improve compliant revenue capture.
Collaborate with coding educators and service line leaders to bridge gaps between clinical and revenue cycle processes.