HPM Career Opportunities
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Revenue Integrity Specialist
Reports To: Revenue Cycle Leadership
Classification: Salary, non-exempt
Position Summary:
The Revenue Integrity Specialist is responsible for ensuring accurate coding, documentation, and reimbursement processes across the organization. This role analyzes revenue cycle activities, identifies areas of risk, and provides actionable insights to improve financial performance and compliance. The position works closely with providers and internal teams to enhance documentation quality, reduce denials, and optimize charge capture.
Duties & Responsibilities:
- Analyze coding, documentation, and denial data to identify revenue risks and ensure accurate reimbursement.
- Conduct documentation audits to ensure compliance with coding guidelines and payer requirements.
- Perform denial root cause analysis to identify trends and implement solutions that reduce future denials.
- Evaluate prior authorization processes to improve approval rates and minimize revenue delays.
- Review charge capture processes to ensure completeness and accuracy of billed services.
- Collaborate with providers and clinical staff to improve documentation accuracy and coding practices.
- Provide education and feedback to providers to support compliance and optimize reimbursement outcomes.
- Monitor and report key performance indicators (KPIs) such as coding accuracy, denial trends, and revenue recovery.
- Support facility operations by managing ticketing dashboards and addressing revenue cycle issues.
- Utilize EMR systems and reporting tools to track, analyze, and improve revenue integrity processes.
Performance Requirements:
1. Work Quality:
- Completes audits and analyses with a high degree of accuracy and attention to detail.
- Adheres to coding standards, compliance regulations, and organizational policies.
2. Timeliness/Dependability:
- Meets deadlines for audits, reporting, and follow-up actions.
- Consistently manages workload efficiently in a remote environment.
3. Professionalism/Teamwork:
- Maintains a collaborative and respectful approach when working with providers and team members.
- Demonstrates leadership and accountability in independent work.
4. Communication Skills:
- Communicates findings and recommendations clearly and professionally to providers and leadership.
- Effectively translates complex data into actionable insights.
5. Adaptability/Critical Thinking:
- Identifies trends and proactively solves revenue cycle issues.
- Demonstrates flexibility in a fast-paced, evolving healthcare environment.
Minimum Qualifications:
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required
- Strong knowledge of CPT and E&M coding guidelines
- Experience with denial analysis, documentation auditing, and payer rules
- Proficiency in Microsoft Office, particularly Excel
- Experience working with healthcare EMR systems
- Ability to independently identify revenue risks and implement solutions
Experience:
- Minimum of 5 years of healthcare coding experience required
- Experience with prior authorizations, denial management, and HIM processes preferred
- Experience working across multiple facilities or complex healthcare environments preferred
Education:
- High school diploma or equivalent required
- Additional education in Health Information Management, Healthcare Administration, or a related field preferred