Revenue Integrity Specialist
Minneola Healthcare, Minneola, KS, United States
Revenue Integrity Specialist
Position Overview
The Revenue Integrity Specialist is responsible for ensuring accurate charge capture, compliant billing practices, and optimal reimbursement within a Critical Access Hospital (CAH) setting. This role serves as a liaison between clinical departments, coding, billing, and finance to maintain the integrity of the revenue cycle while adhering to Medicare cost‑based reimbursement regulations.
Essential Job Functions
Review and validate charges to ensure accuracy, completeness, and proper documentation
Identify, investigate, and resolve missing, duplicate, or incorrect charges
Conduct routine and targeted audits across departments (e.g., lab, radiology, clinic, outpatient services)
Monitor revenue cycle workflows and identify opportunities to improve charge capture and reduce revenue leakage
Analyze denials and implement corrective actions to prevent recurrence
Collaborate with coding, billing, clinical, and registration teams to resolve discrepancies
Support Chargemaster (CDM) maintenance, including coding, pricing, and revenue code accuracy
Ensure compliance with Medicare regulations, including Critical Access Hospital (CAH) requirements
Provide education and guidance to staff on proper charge capture and documentation practices
Assist in developing and improving revenue integrity policies, procedures, and workflows
Non-essential Job Functions
Assist with special projects, reports, and revenue cycle initiatives as assigned
Participate in committees, meetings, and process improvement efforts
Provide cross‑coverage or support for other revenue cycle functions as needed
Assist with onboarding and training of new staff
Support system upgrades, testing, and workflow implementations
Prepare and present audit findings or educational materials to departments
Maintain knowledge of industry trends, regulatory updates, and best practices
Perform other duties as assigned
Requirements, Knowledge/Skills and Abilities
Knowledge of Medicare regulations, including Critical Access Hospital (CAH) reimbursement methodologies
Understanding of CPT/HCPCS coding, revenue codes, and billing processes
Strong analytical and problem‑solving skills with attention to detail
Ability to identify trends, investigate discrepancies, and implement solutions
Effective communication skills with the ability to educate and collaborate across departments
Strong organizational and time management skills with the ability to manage multiple priorities
Ability to work independently and maintain confidentiality of sensitive information
Proficiency in Microsoft Office applications, especially Excel
Physical Demands and Working Conditions
This position is Hybrid. The role requires prolonged periods of sitting, working at a computer, and performing repetitive tasks such as typing and data entry
The position requires visual acuity to review detailed information on computer screens and the ability to communicate effectively via phone, video conferencing, and electronic communication.
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Essential Job Functions
Review and validate charges to ensure accuracy, completeness, and proper documentation
Identify, investigate, and resolve missing, duplicate, or incorrect charges
Conduct routine and targeted audits across departments (e.g., lab, radiology, clinic, outpatient services)
Monitor revenue cycle workflows and identify opportunities to improve charge capture and reduce revenue leakage
Analyze denials and implement corrective actions to prevent recurrence
Collaborate with coding, billing, clinical, and registration teams to resolve discrepancies
Support Chargemaster (CDM) maintenance, including coding, pricing, and revenue code accuracy
Ensure compliance with Medicare regulations, including Critical Access Hospital (CAH) requirements
Provide education and guidance to staff on proper charge capture and documentation practices
Assist in developing and improving revenue integrity policies, procedures, and workflows
Non-essential Job Functions
Assist with special projects, reports, and revenue cycle initiatives as assigned
Participate in committees, meetings, and process improvement efforts
Provide cross‑coverage or support for other revenue cycle functions as needed
Assist with onboarding and training of new staff
Support system upgrades, testing, and workflow implementations
Prepare and present audit findings or educational materials to departments
Maintain knowledge of industry trends, regulatory updates, and best practices
Perform other duties as assigned
Requirements, Knowledge/Skills and Abilities
Knowledge of Medicare regulations, including Critical Access Hospital (CAH) reimbursement methodologies
Understanding of CPT/HCPCS coding, revenue codes, and billing processes
Strong analytical and problem‑solving skills with attention to detail
Ability to identify trends, investigate discrepancies, and implement solutions
Effective communication skills with the ability to educate and collaborate across departments
Strong organizational and time management skills with the ability to manage multiple priorities
Ability to work independently and maintain confidentiality of sensitive information
Proficiency in Microsoft Office applications, especially Excel
Physical Demands and Working Conditions
This position is Hybrid. The role requires prolonged periods of sitting, working at a computer, and performing repetitive tasks such as typing and data entry
The position requires visual acuity to review detailed information on computer screens and the ability to communicate effectively via phone, video conferencing, and electronic communication.
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