Surgical Revenue Integrity Specialist - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ

Capital Health (US)•Pike, NY

1d•Onsite

About The Position

Responsible for pre-bill revenue protection for surgical and procedural encounters, with primary focus on implant, device, and high-cost supply/drug-supported cases. Performs detailed reconciliation of clinical and financial records to ensure complete and accurate charge capture before claim finalization. Reviews physician operative/procedural reports, implant/device logs, purchasing documentation, and billing detail to identify missing invoices, missing charges, documentation-to-charge mismatches, and related claim-readiness risks. Supports trailer billing workflows by obtaining and validating implant/device invoice support and routing corrections to the appropriate operational teams. This role is part of Revenue Integrity and collaborates with OR/Cath/IR departments, Purchasing/Supply Chain, Pharmacy, Patient Financial Services, and HIM/Coding as needed.

Requirements

High school diploma or equivalent required.
Three years' hospital revenue cycle, charge capture, surgical billing support, OR/Cath/IR account review, or related experience required.
Experience reconciling operative documentation, implant/device records, and pre-bill accounts required.
Strong understanding of hospital charge capture and pre-bill controls for surgical/procedural services.
Working knowledge of CPT/HCPCS, modifiers, revenue codes, and unit-based charging concepts.
Ability to interpret physician operative/procedural reports and correlate to billable services and implant/device usage.
Strong analytical, organizational, and follow-up skills in high-volume, time-sensitive workflows.
Effective communication skills with clinical and non-clinical teams.
Proficiency with EHR/revenue cycle systems, account work queues, and case tracking tools.
Proficiency in Excel and standard reporting tools.

Nice To Haves

Associate degree in healthcare, nursing, health information, business, or related field preferred.
Experience with surgical/procedural case workflows (OR, Cath Lab, IR, Endo, etc.) strongly preferred.
Registered Nurse (RN) license preferred, not required.
Non-RN candidates must demonstrate strong competency in interpreting operative/procedural documentation for charge integrity purposes.

Responsibilities

Performs pre-bill surgical revenue integrity review for designated accounts, prioritizing implant/device/high-dollar procedural encounters.
Reviews and interprets physician operative/procedural reports to validate that services performed are accurately reflected in pre-bill charging records.
Reconciles implant/device/supply usage across operative documentation, implant logs, supply chain/purchasing records, and account-level charge detail.
Supports trailer billing workflows by obtaining, validating, and routing implant/device invoice support to appropriate teams for compliant claim submission.
Identifies and documents defects including missing implant invoice, implant not billed, missing OR/procedural charges, under-coded units, and documentation-to-charge mismatch.
Coordinates with OR/Cath/IR leadership, Purchasing/Supply Chain, Pharmacy, and billing teams to resolve identified issues before claim release.
Applies hold/release standards for unresolved high-risk surgical accounts and escalates per policy to protect filing timeliness and revenue.
Initiates and tracks correction requests through established correction pathways and ensures closure of issues.
Documents account findings, issue category, root cause, action taken, and final disposition in designated Revenue Integrity tools/trackers.
Identifies recurring defect trends by facility, service line, physician, procedure, or workflow and escalates systemic issues to Revenue Integrity leadership.
Participates in daily/weekly Revenue Integrity operations huddles and contributes to standard work improvements.
Escalates clinically ambiguous documentation scenarios to RN leadership per defined escalation standards.
Supports onboarding, cross-training, and maintenance of workflow documentation as assigned.
Performs other duties as assigned.