Revenue Integrity Supervisor - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ

Capital Health (US)•Pike, NY

1d•Onsite

About The Position

Leads daily operations of Revenue Integrity work queues and staff, ensuring accurate, compliant, and timely pre-bill claim readiness across hospital and ambulatory services. Responsible for frontline execution, quality control, escalation management, and team coaching across charge integrity, authorization integrity, surgical implant/device reconciliation, and CDM support workflows. Ensures high-risk accounts are identified and corrected prior to billing, with specific operational oversight of pre-bill charge verification, authorization validation pre-service and post-procedure pre-bill to ensure the authorization aligns with procedures actually performed. Partners closely with clinical departments, central scheduling, pharmacy, patient financial services, and informatics to resolve upstream defects and prevent revenue leakage.

Requirements

Associate degree in Nursing, Health Information, Healthcare Administration, Business, or related field required.
Four years' progressively responsible experience in hospital revenue cycle, revenue integrity, patient financial services, or related function required.
Demonstrated experience with pre-bill charge review, authorization workflows, and account-level correction processes required.
Strong knowledge of hospital charge capture, CPT/HCPCS/revenue code usage, and claim workflow dependencies.
Strong understanding of payer authorization requirements and procedure/auth alignment risks.
Strong analytical, organizational, and follow-through skills with the ability to manage high-volume, time-sensitive work queues.
Strong communication and conflict-resolution skills across clinical, operational, and physician office stakeholders.
Ability to coach staff, enforce standards, and drive accountability.
Proficiency in EHR and revenue cycle systems, work queues, and account review tools.
Strong Excel and reporting/dashboard proficiency.
Ability to document trends, root causes, and corrective action plans.
Ability to function with minimal supervision and exercise sound judgment.
Ability to collect, create and research complex or diverse information.

Nice To Haves

Bachelor’s degree preferred.
One year' lead/supervisory experience preferred.
Experience with procedural areas (OR, Cath Lab, IR, imaging, cardiology, etc.) preferred.

Responsibilities

Supervises day-to-day Revenue Integrity operations and staff performance across assigned work queues.
Assigns, prioritizes, and monitors work based on risk, filing timeliness, and financial exposure.
Oversees pre-bill charge integrity review, including missing/incorrect CPT, HCPCS, revenue code, and unit corrections.
Oversees authorization integrity workflows including: pre-service verification that required authorizations are present and accurate, and post-procedure pre-bill validation that approved authorization(s) match procedures actually performed (CPTs, units, setting, dates, site of service).
Oversees surgical/procedural revenue integrity controls, including implant/drug/device reconciliation, invoice availability checks, and hold/release management for unresolved high-risk accounts.
Coordinates daily escalation management with Central Scheduling, procedural departments, physician offices, pharmacy, and billing to resolve issues before claim finalization.
Enforces standard documentation requirements for account notes, issue categorization, action tracking, and closure rationale.
Performs quality audits of teamwork, provides feedback, and drives corrective action for performance and process variation.
Participates in review of operational KPIs (volume, aging, correction turnaround time, preventable risk, escalation outcomes, repeat root causes) and makes adjustments to workload prioritization as needed.
Partners with CDM resources to route and prioritize recurring build/maintenance defects identified through account-level review.
Supports implementation of policy changes, payer rule updates, and workflow redesign under direction of the Manager, Revenue Integrity.
Maintains cross-functional working relationships and participates in recurring operational huddles and governance meetings.
Coaches team members, supports onboarding/training, and builds bench strength for role continuity and succession.
Performs other duties as assigned.