Revenue Integrity Specialist

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.

Responsibilities include:

• Ensuring accurate CPT/HCPCS documentation for patient billing and educating colleagues and ancillary departments on proper documentation and coding practices.
• Performing charge capture activities and supporting charge documentation integrity.
• Handling coding functions, including CPT review, documentation review, and claim denial review.
• Working pre-bill edits within key metrics such as OCE/CCI and DNFB.
• Supporting ancillary departments by identifying duplicate charges, ensuring supply charges are captured, and escalating documentation or charge deficiencies.
• Performing charge entry, charge approvals, and quality charge reviews, including modifier application and clinical documentation checks.
• Validating charges for more complex service lines with advanced proficiency in surgical or specialty coding.
• Educating clinical staff on documentation requirements to support revenue optimization and integrity.
• Analyzing clinical and billing data to identify documentation, coding, and charging issues.
• Collaborating with leadership and clinical teams to improve revenue cycle performance and ensure charges are documented, captured, and reconciled.