Revenue Integrity Specialist

Raleigh General Hospital is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others.

About the role

The Revenue Integrity Specialist plays a key role in protecting and optimizing hospital reimbursement by identifying revenue opportunities, resolving billing and payer issues, and managing denials, audits, and appeals. This role partners across clinical and revenue-cycle teams to improve processes, ensure billing and regulatory compliance, and strengthen the organization's ability to capture all reimbursement to which it is entitled.

Responsibilities

• Drive Revenue Integrity: Coordinate, evaluate, and measure revenue integrity operations to identify opportunities that improve reimbursement, reduce revenue leakage, and strengthen overall revenue-cycle performance.
• Manage Denials, RACs & Appeals: Coordinate RAC and payer audit requests, maintain tracking systems, manage documentation and submission timelines, and support denial and appeal resolution.
• Analyze Revenue & Reimbursement Trends: Develop and maintain tracking mechanisms to identify loss leaders, denial trends, reimbursement opportunities, and improvements by service line, payer, and provider.
• Strengthen Medical Necessity & Authorization Processes: Perform or support medical necessity reviews, verify insurance benefits, obtain required authorizations and precertifications, and identify issues that may impact reimbursement.
• Improve Billing Accuracy & Compliance: Partner with operational and clinical teams to support accurate charging, coding, claim submission, and reimbursement while maintaining compliance with CPT/HCPCS, UB-04, modifiers, Medicare APCs, payer requirements, and applicable regulations.
• Lead Cross-Functional Process Improvement: Collaborate with Scheduling, Registration, Clinical Departments, HIM, Managed Care & Reimbursement, Supply Chain, and Business Office teams to identify root causes and implement sustainable revenue-cycle improvements.
• Educate & Engage Staff: Develop educational materials, communicate audit and denial findings, and provide training and competency support to staff whose activities impact revenue integrity and clean claims.
• Support Compliance & Continuous Improvement: Assist with SOX audits, insurance denial appeals, government correspondence, policy and procedure development, and regulatory monitoring while identifying opportunities to prevent recurring revenue-cycle issues.

Requirements

• High school diploma or equivalent required. College education or at least two years of relevant experience preferred.
• Two years of hospital revenue cycle experience preferred; physician billing and reimbursement experience is a plus.
• Hospital Revenue Cycle Expertise: Strong knowledge of patient accounting, hospital bill processing, insurance practices, billing systems, and their uses, capabilities, and limitations.
• Coding & Billing Knowledge: Demonstrated knowledge of CPT/HCPCS, diagnosis and revenue codes, UB-04, modifiers, Medicare APCs, and other hospital coding and billing requirements.
• Reimbursement & Regulatory Knowledge: Working knowledge of Medicare IPPS and OPPS, Medicaid, commercial payer guidelines, and applicable billing and reimbursement regulations.
• Hospital Charging & Reimbursement: Strong understanding of hospital charging, rate structures, reimbursement methodologies, and the ability to analyze reimbursement and identify opportunities or issues.
• Analytical & Problem-Solving Skills: Ability to research and resolve complex revenue-cycle issues, analyze information, identify root causes, and clearly articulate audit and reimbursement findings.
• Communication & Technical Skills: Strong written and verbal communication skills, proficiency with Excel and other computer-based systems, strong organizational and multitasking abilities, and the ability to work effectively with internal and external customers.
• Initiative & Adaptability: Self-starter who is willing to learn new responsibilities, adapt to changing priorities, manage multiple tasks, and perform effectively with minimal supervision.

About the team

At Raleigh General Hospital, people are our passion and purpose. We offer a wide range of surgical services as well as specialty programs including Cardiac CTA, Digital Mammography, and Trauma Services. Raleigh General Hospital cares for nearly 13,000 patients each year and treats more than 50,000 patients in its emergency room. We are accredited by the Joint Commission and offer instructional programs for nursing students as well as numerous allied health student extern programs.

Benefits

• Multiple levels of medical, dental, and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave, and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance, and 401(k) retirement package with company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services, and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.

Schedule

Full-Time; Days