Revenue Integrity Specialist

About the role

The Revenue Integrity Specialist serves as the key liaison and subject matter expert for assigned service line areas regarding all aspects of charge capture and charge description master processes. This position leads, supports, and coordinates ongoing charge capture improvement initiatives, including charge reconciliation, new service implementation, and identification of revenue management opportunities. The role also involves coordinating revenue integrity activities, department charge capture education, charge audit activities, charge description master management, and monitoring charge capture-related metrics.

This position requires a broad understanding of all areas of the revenue cycle, including Patient Financial Services (PFS), Health Information Management (HIM), and Reimbursement Services.

Responsibilities

• Assesses efficiency and accuracy of revenue cycle operations for assigned clinical areas.
• Functions as the Project Manager for revenue cycle process assessments twice per year, covering registration, charge capture, coding, documentation, billing, reconciliation, payer reimbursement, and compliance.
• Uses established project management tools and methodology to conduct revenue cycle assessments, including identifying project leadership, defining scope, and developing assessment plans.
• Conducts assessment activities such as interviews, outcomes analysis, process flows, documentation reviews, and direct clinical observations.
• Identifies quick hits and redesign opportunities for each project and communicates progress, critical factors, and obstacles to key stakeholders.
• Assists in developing metrics for ongoing monitoring and prepares high-quality reports of findings for various audiences.
• Implements quick hit items within designated timeframes and monitors revenue activity after process improvements.
• Works toward meeting institutional goals of increasing revenue through improved charge capture processes.
• Performs activities to ensure proper and accurate reimbursement, including conducting third-party payer and externally requested chart/bill audits.
• Conducts pre-audits 100% of the time prior to scheduled audit dates and schedules audits within 10 days of the request 95% of the time.
• Completes post-audit paperwork and communicates significant findings to appropriate managers within 2 weeks of audit completion.
• Maintains knowledge of clinical care, billing, coding compliance rules, and other pertinent regulations, completing 24 hours of continuing education annually.
• Prepares formal reports and presentations on revenue cycle assessment findings for clinical staff, department managers, administration, and other stakeholders.
• Supports the Revenue Analytics Team with month-end close and provides clinical care and billing guidance for contract negotiations.
• Collaborates with Internal Audit, Billing Compliance Departments, and PFS to resolve billing or collection issues.
• Assists with other projects as necessary.

Requirements

• Bachelor’s degree in a clinical program required; Master’s degree preferred.
• Minimum five (5) years of varied clinical experience as a Registered Nurse (RN), Advanced Practice Nurse (APN), or other clinical specialist; pediatric experience preferred.
• Working knowledge of coding rules required or willingness to obtain within 3 months of hire.
• Experience with billing and documentation systems preferred.
• Registered Nurse (RN) license in Pennsylvania required upon hire.
• Coding certification (e.g., Certified Professional Coder (CPC)) preferred.

Skills

• Registered nurse or other licensed healthcare practitioner preferred (PA/NJ licensing preferred).
• Clinical expertise in pediatrics preferred.
• Ability to work effectively with all members of the healthcare team.
• Working knowledge of chart/bill audits or ability to abstract medical information.
• Strong analytical, organizational, and project management skills.
• Excellent verbal and written communication skills.
• Ability to work independently and manage multiple complex projects simultaneously.
• Detail-, action-, solution-, and results-oriented.
• Working knowledge of revenue cycle processes.
• Proficiency in Microsoft Word, Excel, PowerPoint, and Visio.

Schedule

Duration: 3 months to start.