Revenue Integrity Specialist
Minneola Healthcare•Minneola, KS
•Hybrid
About The Position
The Revenue Integrity Specialist is responsible for ensuring accurate charge capture, compliant billing practices, and optimal reimbursement within a Critical Access Hospital (CAH) setting. This role serves as a liaison between clinical departments, coding, billing, and finance to maintain the integrity of the revenue cycle while adhering to Medicare cost-based reimbursement regulations.
Requirements
- Knowledge of Medicare regulations, including Critical Access Hospital (CAH) reimbursement methodologies
- Understanding of CPT/HCPCS coding, revenue codes, and billing processes
- Strong analytical and problem-solving skills with attention to detail
- Ability to identify trends, investigate discrepancies, and implement solutions
- Effective communication skills with the ability to educate and collaborate across departments
- Strong organizational and time management skills with the ability to manage multiple priorities
- Ability to work independently and maintain confidentiality of sensitive information
- Proficiency in Microsoft Office applications, especially Excel
Responsibilities
- Review and validate charges to ensure accuracy, completeness, and proper documentation
- Identify, investigate, and resolve missing, duplicate, or incorrect charges
- Conduct routine and targeted audits across departments (e.g., lab, radiology, clinic, outpatient services)
- Monitor revenue cycle workflows and identify opportunities to improve charge capture and reduce revenue leakage
- Analyze denials and implement corrective actions to prevent recurrence
- Collaborate with coding, billing, clinical, and registration teams to resolve discrepancies
- Support Chargemaster (CDM) maintenance, including coding, pricing, and revenue code accuracy
- Ensure compliance with Medicare regulations, including Critical Access Hospital (CAH) requirements
- Provide education and guidance to staff on proper charge capture and documentation practices
- Assist in developing and improving revenue integrity policies, procedures, and workflows
- Assist with special projects, reports, and revenue cycle initiatives as assigned
- Participate in committees, meetings, and process improvement efforts
- Provide cross-coverage or support for other revenue cycle functions as needed
- Assist with onboarding and training of new staff
- Support system upgrades, testing, and workflow implementations
- Prepare and present audit findings or educational materials to departments
- Maintain knowledge of industry trends, regulatory updates, and best practices
- Perform other duties as assigned
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
