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

Position Overview

Responsible for account-level pre-bill charge verification to ensure accurate, complete, and compliant claim construction before final billing.

Responsibilities

• Identifies charge defects including missing CPT/HCPCS, incorrect procedure codes, missing/incorrect modifiers, unit discrepancies, and revenue code inconsistencies.
• Reconciles charges to supporting documentation (for example procedural notes, implant/device logs, ancillary documentation, and departmental records).
• Validates that itemized charges align to services actually performed and documented before claim finalization.
• Initiates and tracks charge corrections through established pathways (for example correction work queues, department outreach, and billing correction tools).
• Applies hold/release criteria for unresolved high-risk charging issues prior to claim submission.
• Communicates required corrections and supporting rationale to billing, coding, and clinical department contacts within defined turnaround expectations.
• Documents issue category, root cause, action taken, and final disposition in designated tracking systems.
• Performs follow-up on open correction items to ensure closure within policy and timely filing limits.
• Identifies recurring defect patterns by department, procedure, payer, or workflow and escalates systemic issues to Revenue Integrity leadership.
• PARTNERS WITH AUTHORIZATION INTEGRITY, SURGICAL REVENUE INTEGRITY, AND CDM TEAMS TO CLOSE UPSTREAM PROCESS GAPS IMPACTING CHARGE ACCURACY.
• SUPPORTS QUALITY REVIEW ACTIVITIES AND COMPLIES WITH STANDARD WORK, AUDIT REQUIREMENTS, AND DOCUMENTATION STANDARDS.
• SUPPORTS ONBOARDING, CROSS-TRAINING, AND WORKFLOW UPDATES AS ASSIGNED.
• PERFORMS OTHER DUTIES AS ASSIGNED.

Requirements

• Education: High school diploma or equivalent required. Associate degree in healthcare, business, nursing, health information, or related field preferred.
• Experience: Three years' experience in hospital revenue cycle, charging, billing edits, charge capture, or related function required. Experience with pre-bill account review and correction workflows preferred. Experience with Medicare and Managed Medicare claim requirements preferred. Procedural area experience (OR, Cath Lab, IR, imaging, cardiology, etc.) preferred.

Qualifications

• Strong understanding of hospital charge capture and claim flow dependencies.
• Working knowledge of CPT/HCPCS, revenue codes, modifiers, and unit-based charging concepts.
• Ability to reconcile documentation, itemized charges, and expected services performed.
• Strong analytical, organizational, and follow-through skills.
• Effective written and verbal communication across clinical and operational teams.

Skills

• Proficiency with EHR/revenue cycle systems, charging work queues, and account review tools.
• Proficiency in Excel and standard reporting/issue tracking tools.

Benefits

• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA)
• Healthcare FSA
• Dependent Care FSA
• Retail Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits – Long Term Disability (LTD)
• Disability Benefits – Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance
• Voluntary Life Spouse Voluntary Life
• Employee Voluntary Life
• Child Voluntary Life
• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program