Revenue Integrity Specialist

This is a fully remote position, open to applicants in Washington.

📋 Description

• Conduct research and analyze coding-related denials and interruptions in revenue flow.

• Detect patterns in payer behavior, coder trends, or issues within systems.

• Manage denial work queues and execute hands-on remediation efforts.

• Monitor escalations and liaise with the Payer Relations and Hospital Billing teams.

• Generate revenue-related reports utilizing SlicerDicer and Reporting Workbench.

• Support operational owners in understanding charge reconciliation.

• Act as a subject matter expert on facility payment models and the technical flow of charges through Epic.

• Spot opportunities for automation and the implementation of AI to enhance compliant revenue capture.

• Collaborate with coding educators and service line leaders to connect clinical processes with revenue cycle operations.

⛳️ Requirements

• An associate degree in Health Information Management or a related field, or equivalent relevant work experience.

• At least five years of experience in coding and abstracting clinical information in an acute care hospital context or a comparable setting.

• Direct experience with both facility and professional coding practices and standards.

• A minimum of one year of experience in a Revenue Integrity-related position.

• Certification as a Certified Coding Specialist (CCS) by AHIMA, or as a Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) by AAPC.

• RHIT or RHIA certification with a commitment to obtain a relevant coding credential within six months of hire.

• Understanding of facility payment models (DRG, APC, EAPG).

• Knowledge of technical charge flow through Epic for both inpatient and outpatient services.

• Preferred: Bachelor’s degree.

• Preferred experience in an academic acute care environment.

• Preferred experience in a pediatric acute care setting.

• Preferred familiarity with EPIC.

• Preferred experience with SharePoint and instructional design.

• Preferred experience in managing coding denials and the appeals process.

• Preferred experience in researching payer policies and coding guidelines.

• Preferred experience with decision support systems.

• Preferred experience with encoders (3M).

• Proficient use of Excel, Word, and PowerPoint.

🏝️ Benefits

• Medical, dental, and vision insurance plans.

• 403(b) retirement plan.

• Life insurance coverage.

• Paid time off.

• Tuition reimbursement.