Revenue Integrity Specialist

The Revenue Integrity Specialist is responsible for supporting the organization's revenue cycle by ensuring accurate charge capture, billing, and reimbursement through the effective use of Epic and other revenue cycle systems. This position reviews and resolves charge and claim edits, monitors Epic work queues, assists with Charge Description Master (CDM) maintenance, validates charging workflows, and collaborates with clinical and revenue cycle departments to improve billing accuracy, reduce denials, and prevent revenue leakage. The Revenue Integrity Specialist serves as a resource for departments by identifying billing issues, educating staff on charging processes, and supporting compliance with federal, state, and payer regulations.

Responsibilities

Monitor and resolve assigned Epic work queues related to charge review, charge router, claim edits, and billing exceptions; Research and resolve charging discrepancies prior to claim submission; Correct charging errors within Epic while maintaining compliance with organizational policies; Document findings and actions taken within Epic and other designated tracking systems; Review charge reconciliation reports to identify missing, duplicate, or inaccurate charges; Verify that documented services are appropriately charged and billed; Collaborate with clinical departments to resolve charging discrepancies; Review and resolve claim edits related to coding, modifiers, medical necessity, payer requirements, and billing compliance; Support departmental audits related to charge capture, documentation, and billing accuracy; Collaborate with Coding, Patient Financial Services, Patient Access, and clinical departments to resolve billing issues

Requirements

High school diploma or equivalent; Ability to read, write, and understand policies, labels, and written instructions; Strong knowledge of CPT/HCPCS, revenue codes, and payer billing guidelines; Two+ years of experience in hospital revenue cycle, chargemaster maintenance, or medical billing/coding; Experience with hospital billing systems Epic; Ability to manage time, tasks, and resources appropriately; Excellent communication skills with colleagues and customers

Nice to have

Certification in coding (CPC, CCS, or equivalent)

Benefits

Medical/Vision, Dental, Health Savings Account, and Paid Leave Time; Employer Paid Life Insurance and Long-Term Disability; Retirement with Employer Matching Contributions; Voluntary Benefits that include Life Insurance, Critical Illness, Accident Insurance, and Short-Term Disability; Services Discount and EAP Resources