Revenue Integrity Specialist PB

About Us

We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality, and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare.

About the Role

Inova 8095 - Fairfax East is looking for a dedicated Revenue Integrity PB Specialist to join the team. This role will be full-time day shift Monday – Friday during business hours.

Responsibilities

• Work with revenue-producing clinical departments/service lines across the Inova enterprise to ensure efficient, accurate, and compliant charge capture and charge reconciliation processes.
• Align with department/service line leadership and serve as the subject matter expert regarding the accuracy of charge capture processes, including education, audit activities, changes or risk to revenue (regulatory or coding changes), and monitoring of charge capture-related metrics to minimize revenue leakage.
• Work with service line leaders to ensure regulatory compliance for new and existing services, implement charge capture process improvements, and annual updates to CPT/HCPCS code selections.
• Collaborate with service lines, HIM, and other key stakeholders to improve charge capture, compliant documentation to substantiate charges, charge reconciliation, and compliant billing of all charges.
• Scope of work includes claim edits (CCI/LCD), follow-up denials, customer service/patient complaints, write-off requests, specialty projects, and training in charge entry.
• Ensure accurate and complete assignment of CPT/HCPCS codes, modifiers, and diagnoses that are supported by medical record documentation.
• Analyze charge review findings and recommend improvements to Revenue Cycle administration leadership to enhance documentation, charging flow, and accuracy.
• Review denial trends for documentation and charging opportunities and provide feedback on educational gaps.
• Perform appropriate analytics as daily work queue management functions are performed; verify billing data for accuracy and completeness; perform charge reviews by verifying billing data compared to documentation and make corrections in patient accounting as needed.
• Partner with the Billing team counterparts to determine how claim errors related to coding or charge review are resolved for accurate billing of claims for payment.
• Review, monitor, and resolve claims; evaluate if account combinations and account splits are appropriately applied.
• Perform medical necessity validation to ensure timely and accurate processing of claims.
• Review Inova Health System registration communications, applicable Centers for Medicaid & Medicare Services transmittals, National Coverage Decisions, and Local Coverage Decisions.
• Provide support to manager to review and interpret revenue cycle reports to drive accountability and transparency in performance.
• Provide ongoing support to manager to improve service line charge capture and charge reconciliation workflows.
• Review analytics to validate accurate charge capture and reporting of charges; identify issues, perform root/cause analysis, and propose solutions to manager.
• Review denials transferred from PFS team, analyze root cause, correct, or provide appeal support for claims as necessary, and document denials in tracker for trending analysis.
• Review Claim Edit WQs and proactively resolve and propose solutions to prevent charging edits.
• Work closely with Health Information Management (HIM), Clinical Documentation Improvement (CDI), Clinical Informatics, and Patient Financial Services (PFS) departments to resolve charge capture-related issues.
• Maintain knowledge of any CDM requests for the assigned department(s)/service line(s) and support effective implementation and education.
• Maintain knowledge of Electronic Health Record (EHR) reports and resources available to the RI team by working collaboratively with EHR IT.
• Participate actively in team development, achieving KPIs, and accomplishing department goals.
• Perform additional duties as assigned.

Requirements

• Certification as a Certified Coding Specialist or AAPC/AHIMA: RHIT, RHIA, CCS, CPC, CPC-H.
• Five years of experience in either a coding or billing role.
• Associate’s Degree in a healthcare or finance-related field.

Benefits

• Committed to Team Member Health: Offering medical, dental, and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance: Offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: Offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: Offering paid time off and paid parental leave.

Schedule

Full-time day shift, Monday – Friday during business hours.