North Florida Surgeons, P.A. Verified
Health Care, Medical Practice, Surgery
Revenue Integrity Specialist
Jacksonville, FLOnsiteFull TimePosted 11 hours ago
Required skills
- charge capture
- billing
- reimbursement
- revenue leakage
- charge reconciliation
- charge capture audits
- charge exceptions
- billing edits
- claim denials
- reimbursement variances
Nice to have
- Healthcare Administration
- Business Administration
- Finance
- multi-specialty physician group
- CPC
- CPB
Role summary
The Revenue Integrity Specialist ensures the accuracy, compliance, and optimization of healthcare revenue cycle processes, including charge capture, coding, billing, and reimbursement. This role acts as a liaison between various departments to identify revenue leakage, improve reimbursement, and maintain regulatory compliance. Responsibilities include conducting audits, analyzing billing data, managing charge masters, preventing denials, and educating staff. The position requires strong analytical, problem-solving, and communication skills, with advanced Excel capabilities for reporting and KPI tracking.
Revenue Integrity Specialist Position Summary The Revenue Integrity Specialist is responsible for ensuring the accuracy, compliance, and optimization of charge capture, coding, billing, and reimbursement processes across the organization. This position serves as a liaison between clinical operations, patient financial services, coding, compliance, credentialing, and revenue cycle teams to identify revenue leakage, improve reimbursement, and maintain regulatory compliance. Essential Duties and Responsibilities Revenue Integrity & Charge Capture
- Conduct routine charge reconciliation and charge capture audits to identify missed, duplicate, or inaccurate charges.
- Investigate and resolve charge exceptions and revenue leakage opportunities.
- Analyze billing edits, claim denials, and reimbursement variances to identify root causes.
- Review charge master (CDM) and fee schedule accuracy and recommend updates.
- Monitor service line charging practices and ensure consistency across specialties.
- Validate provider documentation supports services rendered and billed.
- Collaborate with coding teams to identify documentation and coding opportunities.
- Review coding trends and reimbursement impacts.
- Ensure compliance with Medicare, Medicaid, commercial payer, and regulatory billing requirements.
- Monitor regulatory updates impacting billing, coding, and reimbursement.
- Assist with internal compliance audits and corrective action plans.
- Prepare revenue integrity reports and dashboards.
- Track key performance indicators including:
- Charge lag
- Charge capture rates
- Revenue leakage
- Denial rates
- Underpayments
- Net collection rates
- Analyze trends and present findings to leadership.
- Identify denial trends related to registration, authorization, coding, and charge entry.
- Collaborate with operational departments to implement preventive measures.
- Support recovery efforts for underpayments and missed billing opportunities.
- Educate providers and staff regarding documentation, charging, coding, and reimbursement requirements.
- Develop training materials and job aids.
- Participate in onboarding and ongoing educational programs.
- Work closely with:
- Revenue Cycle Management
- Coding
- Compliance
- Clinical Departments
- Credentialing
- Contracting
- Information Technology
- Managed Care
- Associate's degree required.
- Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field preferred.
- 3-5 years of healthcare revenue cycle experience.
- Experience with physician practice operations, coding, charging, billing, or denial management.
- Multi-specialty physician group experience preferred.
- CPC
- CPB
- CPMA
- COC
- CRC
- RHIT
- RHIA
- CHRI (Certified Healthcare Revenue Integrity)
- Strong understanding of physician and facility revenue cycle processes.
- Knowledge of CMS regulations and payer guidelines.
- Advanced Excel and reporting capabilities.
- Strong analytical and problem-solving skills.
- Excellent communication and presentation skills.
- Ability to manage multiple priorities independently.
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