Revenue Integrity Specialist

UAB St. Vincent's•Birmingham, AL

14h•Onsite

About The Position

The Revenue Integrity Specialist supports revenue optimization, regulatory compliance, and charge capture integrity across the enterprise by collaborating with clinical departments, Revenue Cycle, Health Information Management (HIM), Health Information Technology (IT), and other key stakeholders. This role performs advanced edits, validations, and in-depth analytical reviews, applying strong judgment to identify trends, resolve complex issues, and support accurate reimbursement and sustainable revenue practices.

Requirements

RHIA, RHIT, CCS, CPC/COC/CIC, AAPC, or other coding credentials required.
Bachelor’s degree in finance, Accounting, Management, or hospital-related fields.
Minimum of three years of experience in billing, charge documentation, charge audit, or charge capture activities, or otherfunctions related to revenue cycle activities

Nice To Haves

HFMA Certified Revenue Cycle Specialist (CRCS), HFMA Certified Revenue Cycle Specialist (CRCS) certifications preferred.

Responsibilities

Responsible for ensuring accurate CPT/HCPCS documentation for the patient billing process and educating colleagues and ancillary departments in accurately documenting services performed, and using appropriate codes representing those services. Responsible for charge capture in the Revenue Integrity assigned areas, if applicable. Performs coding functions, including CPT, documentation review, and claim denial review. Review's documentation, abstract data, and ensure charges/coding are in alignment with AMA and Medicare coding guidelines.
Responsible for working the pre-bill edits within key metrics, including but not limited to OCE/CCI, & DNFB.
Provides “at-elbow support” to ancillary departments, including but not limited to ensuring supply charges are appropriately captured (may include implants), identifying duplicate charges, and initiating appropriate communications when there are documentation and/or charge deficiencies or charge errors.
Performs charge entry, charge approvals, and/or quality charge reviews, including but not limited to, appending modifiers and checking clinical documentation. Provides feedback to intra-departmental Revenue Integrity colleagues, including areas of opportunity.
Responsible for coding and/or validation of charges for more complex service lines, with advanced proficiencies in surgical or specialty coding practice.
Educates clinical staff on the need for accurate and complete documentation to ensure revenue optimization and integrity. Provides consultation training and other assistance to clinical departments regarding charge protocol issues to ensure charge sheets/screens are updated, and processes are in place to capture all daily charges.
Provides ongoing feedback and prepares and analyzes trends relating to clinical and billing data to identify documentation, coding, and charging issues.
Works closely with clinical areas to effectively document services performed and understand the relationship of documentation, medical necessity, coding and charging for all services provided.
Identifies trends, collaboratively works with leadership to help improve the revenue cycle performance within the hospital and/or Ambulatory Clinics.
Works collaboratively with the revenue-producing department leadership and clinical care sites to ensure all charges are being documented, captured, and reconciled.