Revenue Integrity Specialist
About The Position
The Revenue Integrity Specialist supports revenue optimization, regulatory compliance, and charge capture integrity across the enterprise. The role collaborates with clinical departments, Revenue Cycle, Health Information Management, Health Information Technology, and other stakeholders. It performs advanced edits, validations, and analytical reviews, using judgment to identify trends, resolve complex issues, and support accurate reimbursement and sustainable revenue practices. The specialist ensures accurate CPT/HCPCS documentation and coding for patient billing, supports charge capture in assigned areas when applicable, performs coding and claim-denial reviews, reviews documentation and abstracted data, and checks alignment with AMA and Medicare coding guidelines. The role also works pre-bill edits, supports ancillary departments with charge issues, performs charge entry and quality reviews, educates clinical staff, analyzes clinical and billing trends, and collaborates with leadership and clinical areas to improve revenue-cycle performance and ensure charges are documented, captured, and reconciled.
Requirements
- Bachelor’s degree in Finance, Accounting, Management, or a hospital-related field.
- Minimum of three years of experience in billing, charge documentation, charge audit, charge capture activities, or other revenue-cycle-related functions.
- RHIA, RHIT, CCS, CPC/COC/CIC, AAPC, or other coding credentials required.
Nice To Haves
- HFMA Certified Revenue Cycle Specialist (CRCS) certification preferred.
Responsibilities
- Ensure accurate CPT/HCPCS documentation for patient billing and educate colleagues and ancillary departments on documenting services and selecting appropriate codes.
- Perform charge capture in assigned Revenue Integrity areas, if applicable.
- Perform coding functions, including CPT coding, documentation review, and claim-denial review; review documentation, abstract data, and ensure charges and coding align with AMA and Medicare coding guidelines.
- Work pre-bill edits within key metrics, including OCE/CCI and DNFB.
- Provide at-elbow support to ancillary departments by ensuring supply charges, including implants when applicable, are captured; identify duplicate charges and communicate documentation or charge deficiencies and errors.
- Perform charge entry, charge approvals, and quality charge reviews, including appending modifiers and checking clinical documentation.
- Provide feedback to Revenue Integrity colleagues, including identifying areas of opportunity.
- Code and/or validate charges for more complex service lines, with advanced proficiency in surgical or specialty coding practice.
- Educate clinical staff about complete and accurate documentation for revenue optimization and integrity; provide consultation, training, and assistance to clinical departments on charge protocols, charge sheets/screens, and processes to capture daily charges.
- Provide ongoing feedback and prepare and analyze trends in clinical and billing data to identify documentation, coding, and charging issues.
- Work with clinical areas to support effective service documentation and understanding of the relationship between documentation, medical necessity, coding, and charging.
- Identify trends and collaborate with leadership to improve revenue-cycle performance within the hospital and/or Ambulatory Clinics.
- Collaborate with revenue-producing department leadership and clinical care sites to ensure charges are documented, captured, and reconciled.
Benefits
- Generous paid time off (eligible positions only).
- Paid parental leave (eligible positions only).
- Associate Assistance Program (eligible positions only).
- Tuition Reimbursement Program (eligible positions only).
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
