Revenue Integrity Specialist
Core
Ensures accurate charge capture, billing, and reimbursement by resolving charge and claim edits, monitoring Epic work queues, and validating charging workflows.
Role type
Revenue Integrity Specialist
Builds
Accurate billing and reimbursement processes for hospital patients
Domain
Healthcare revenue cycle management
Required skills
CPT/HCPCS coding knowledge, revenue codes, payer billing guidelines, Epic system proficiency, charge description master (CDM) maintenance, claim edit resolution, charge reconciliation, audit support
Preferred skills
CPC or CCS certification
Technologies
Epic
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; 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.
Seniority
Mid-level, hands-on specialist
