Revenue Integrity Specialist

Job Description

Job Description

Must reside in California, Texas, Arizona, Utah, Florida, Idaho, Oregon, or Washington and be able to work PST hours.

We are seeking a detail-oriented Revenue Integrity Specialist to support healthcare revenue cycle operations by reviewing claim edits, validating coding accuracy, and ensuring appropriate charge capture and billing practices. This role focuses on researching and resolving coding discrepancies, applying appropriate modifiers, and working assigned claim edits to support timely and accurate reimbursement. The ideal candidate has hospital revenue cycle experience, a strong understanding of medical coding guidelines, and the ability to meet daily productivity and quality expectations.

• Review and resolve revenue integrity claim edits, coding discrepancies, and billing issues to support accurate and timely claim submission.

• Apply appropriate CPT modifiers, including Modifier 25 for separately identifiable evaluation and management services and Modifier 50 for bilateral procedures, when supported by coding guidelines and documentation.

• Review claims containing duplicate CPT codes with LT and RT modifiers and determine when appropriate modifier corrections are necessary.

• Identify coding errors, charge omissions, and billing discrepancies, coordinating with appropriate departments to facilitate corrections.

• Review code pair edits and apply appropriate modifier exceptions in accordance with National Correct Coding Initiative (NCCI) guidelines, avoiding inappropriate unbundling of services.

• Research and troubleshoot accounts held in billing work queues due to coding, charging, or documentation discrepancies.

• Monitor late charges and recurring billing issues, identify root causes, and assist with tracking trends and opportunities for improvement.

• Maintain accurate issue logs documenting findings, corrective actions, and resolution progress.

• Assist with the review and maintenance of chargemaster information, charge documents, and charge capture processes.

• Prepare reports on claim edits, coding accuracy, late charges, and other revenue cycle performance metrics.

• Collaborate with revenue cycle, clinical, and IT teams to resolve routine system issues and support process improvements.

• Assist with maintaining system support tickets and escalating complex issues to the appropriate teams.

• Active coding certification required, such as Certified Professional Coder (CPC) or an equivalent recognized coding credential.

• Experience in medical coding, claims editing, or healthcare revenue cycle operations.

• Working knowledge of CPT coding, modifier application, and claim edit resolution.

• Understanding of Modifier 25 and the appropriate use of Modifiers 50, LT, and RT.

• Familiarity with NCCI edits, code pair restrictions, and appropriate modifier exceptions.

• Ability to meet daily productivity expectations of at least 175 accounts or claim edits while maintaining a minimum 95% quality and accuracy score.

• Strong attention to detail, analytical skills, and the ability to research and resolve coding discrepancies.

• Proficiency in Microsoft Office, particularly Excel, Outlook, Word, and Teams.

• Effective written and verbal communication skills and the ability to work independently while collaborating with cross-functional teams.

• Two or more years of hospital revenue cycle experience, particularly in charge capture, coding, and claims edits.

• Experience reviewing hospital and professional claims and resolving revenue integrity work queues.

• Familiarity with medical terminology, chargemaster maintenance, and billing documentation requirements.

• Experience tracking claim edit trends, identifying root causes, and supporting revenue cycle reporting.

Additional Information: This is a non-patient-facing role focused on coding accuracy, claim edit resolution, and revenue integrity operations.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?