Revenue and Audit Specialist

The Revenue Integrity Specialist ensures billing and revenue accuracy by conducting audits, providing education on charge capture processes, and serving as a liaison to resolve internal billing issues. This role supports revenue-producing departments in maintaining compliance with billing policies, procedures, and guidelines.

Key Responsibilities:

1. Charge Capture Audits:

   • Conduct concurrent, prospective, and retrospective audits to ensure charge capture and billing accuracy.
   • Identify opportunities for process improvements and collaborate with department management to implement solutions.

2. Education & Training:

   • Provide orientation, education, and training to revenue-producing departments regarding charge capture policies and processes.
   • Ensure staff understanding of billing compliance requirements.

3. Liaison Role:

   • Act as a point of contact for hospital departments, assisting with internal billing problem resolution as needed.

Qualifications:

Education & Experience Required:

• 3–4 years of hospital clinical or coding experience.
• Familiarity with third-party healthcare insurance plans.

Certifications:

• Certified Coding Associate (CCA) certification (valid and current).

Skills & Abilities:

• Proficient in hospital applications, Microsoft Office, and Windows.
• Strong communication skills, both written and verbal.
• Ability to analyze patient bills, medical records, and contracts for accuracy and compliance.
• Problem-solving and analytical skills to handle complex billing issues.
• Organizational skills to manage large projects and meet deadlines.
• Ability to work independently and handle confrontational encounters positively.

Physical Requirements & Working Conditions:

• Ability to lift up to 20 pounds.
• Must be able to travel locally for meetings as necessary.
• Capable of coordinating large projects under time pressure.
• Comfortable reading and analyzing medical charts and patient bills.
• Must provide superior customer service across all organizational levels.

Preferred Skills:

• Familiarity with charge capture processes.
• Ability to investigate and interpret billing guidelines, reimbursement policies, and contract language.