Revenue Integrity Specialist

Care New England Health System•Warwick, RI

13h

About The Position

The Revenue Integrity Charge Capture specialist is responsible for ensuring the complete, accurate, and timely capture of hospital and professional charges across Care New England. This role focuses on proactive review and resolution of missing or incorrect charges through daily monitoring of Epic Revenue Guardian reports and charge-related work queues, reconciliation of charges against clinical documentation, and collaboration with operational, clinical, and coding teams to ensure compliance with federal, state, and third-party payor guidelines. The Analyst supports charge integrity by verifying that all services provided are appropriately documented and coded using ICD-10-CM, CPT, and HCPCS classification systems. They perform reconciliation activities to identify gaps or discrepancies in revenue capture, work to correct systemic or documentation-related issues, and escalate concerns as needed. In addition, the Analyst assists with data extraction and reporting, trend identification, and audit preparedness. This role is a vital member of the Revenue Integrity team and serves as a resource to coding, billing, and operational staff regarding charge accuracy, workflow compliance, and revenue optimization strategies. The Analyst plays a critical role in maintaining data integrity, reducing revenue leakage, and supporting a compliant billing environment across the organization.

Requirements

Strong working knowledge of CPT, HCPCS, and ICD-10 coding systems and their application to charge capture and reimbursement.
Comprehensive understanding of healthcare revenue cycle operations, particularly front-end processes and professional/facility charge capture.
Familiarity with Medicare, Medicaid, and commercial payer billing and reimbursement guidelines.
In-depth knowledge of Epic (or comparable EHR/EMR systems), including work queues and Revenue Guardian reporting tools.
Understanding of compliance regulations including HIPAA and CMS guidelines related to billing practices.
Awareness of Charge Description Master (CDM) structure and its impact on charging and reimbursement.
High level of attention to detail, with the ability to review clinical documentation for accurate translation into billable services.
Strong analytical skills to identify trends, discrepancies, and root causes of charge capture issues.
Effective written and verbal communication skills, with the ability to explain complex charge or documentation issues clearly.
Proficiency in Microsoft Excel and other reporting tools to extract, analyze, and present data.
Time management and organizational skills to manage multiple tasks and meet daily/weekly deadlines.
Ability to build productive relationships and collaborate across departments (clinical, billing, IT, compliance).
Ability to work independently while using sound judgment to escalate concerns when appropriate.
Ability to interpret and apply regulatory changes and payer guidelines to operational workflows.
Ability to navigate Epic and other systems to resolve charge capture issues efficiently.
Ability to assess workflow inefficiencies and recommend process improvements.
Ability to manage competing priorities and shift focus quickly in a dynamic environment.
Commitment to maintaining confidentiality and upholding the highest standards of integrity and professionalism.

Nice To Haves

Associate's Degree Preferred

Responsibilities

Review daily Epic Revenue Guardian reports and charge-related work queues to identify and correct missing, incomplete, or inaccurate charges.
Validate charge capture processes are functioning as expected and escalate systemic issues to the Manager of Revenue Integrity.
Reconcile clinical documentation against charge activity to ensure all services rendered are accurately reflected and captured.
Collaborate with clinical departments to clarify documentation discrepancies or omissions impacting charging.
Maintain working knowledge of Medicare, Medicaid, and commercial payor billing requirements, including CMS guidelines.
Apply accurate CPT, HCPCS, and ICD-10 codes during charge validation; escalate issues that need further review.
Serve as a liaison between Revenue Integrity, Coding, Clinical Operations, and Patient Financial Services to resolve charge-related issues.
Communicate professionally and promptly with departments regarding trends, discrepancies, or needed workflow adjustments.
Assist in compiling or addressing daily, monthly, and ad hoc charge-related reports for internal use and leadership review as needed.
Prepare and organize documentation to support internal and external audit activities as needed.
Participate in reviews of CDM (Charge Description Master) and charge workflows for accuracy and efficiency.
Identify opportunities to streamline charge capture processes, reduce errors, and improve documentation practices.
Assist in the development of training materials or process documentation as needed.
Ensure all patient and financial information is handled in compliance with HIPAA regulations and organizational policies.
Demonstrate accountability and initiative in meeting expectations of timeliness, accuracy, and integrity.