Revenue Integrity Specialist

North Florida Surgeons, P.A.•Jacksonville, FL

10h

About The Position

The Revenue Integrity Specialist ensures the accuracy, compliance, and optimization of charge capture, coding, billing, and reimbursement processes across the organization. The role serves as a liaison among clinical operations, patient financial services, coding, compliance, credentialing, and revenue cycle teams to identify revenue leakage, improve reimbursement, and maintain regulatory compliance. The specialist audits and reconciles charges, investigates exceptions, analyzes billing edits, denials, and reimbursement variances, and reviews charge master and fee schedule accuracy. The role also supports coding and compliance activities, prepares revenue integrity reports and dashboards, helps prevent and recover denials and underpayments, and educates providers and staff on documentation, charging, coding, and reimbursement requirements.

Requirements

Associate's degree required.
3-5 years of healthcare revenue cycle experience.
Experience with physician practice operations, coding, charging, billing, or denial management.
Strong understanding of physician and facility revenue cycle processes.
Knowledge of CMS regulations and payer guidelines.
Advanced Excel and reporting capabilities.
Strong analytical and problem-solving skills.
Excellent communication and presentation skills.
Ability to manage multiple priorities independently.

Nice To Haves

Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field.
Multi-specialty physician group experience.
CPC, CPB, CPMA, COC, CRC, RHIT, RHIA, or CHRI (Certified Healthcare Revenue Integrity) certification.

Responsibilities

Conduct routine charge reconciliation and charge capture audits to identify missed, duplicate, or inaccurate charges.
Investigate and resolve charge exceptions and revenue leakage opportunities.
Analyze billing edits, claim denials, and reimbursement variances to identify root causes.
Review charge master (CDM) and fee schedule accuracy and recommend updates.
Monitor service line charging practices and ensure consistency across specialties.
Validate provider documentation supports services rendered and billed.
Collaborate with coding teams to identify documentation and coding opportunities.
Review coding trends and reimbursement impacts.
Ensure compliance with Medicare, Medicaid, commercial payer, and regulatory billing requirements.
Monitor regulatory updates impacting billing, coding, and reimbursement.
Assist with internal compliance audits and corrective action plans.
Prepare revenue integrity reports and dashboards.
Track charge lag, charge capture rates, revenue leakage, denial rates, underpayments, and net collection rates.
Analyze trends and present findings to leadership.
Identify denial trends related to registration, authorization, coding, and charge entry.
Collaborate with operational departments to implement preventive measures.
Support recovery efforts for underpayments and missed billing opportunities.
Educate providers and staff regarding documentation, charging, coding, and reimbursement requirements.
Develop training materials and job aids.
Participate in onboarding and ongoing educational programs.
Work closely with Revenue Cycle Management, Coding, Compliance, Clinical Departments, Credentialing, Contracting, Information Technology, and Managed Care.