Revenue Integrity Specialist

Revenue Integrity Specialist

The Revenue Integrity Specialist is responsible for working with revenue-producing clinical departments/service lines across the Inova enterprise to ensure efficient, accurate, and compliant charge capture and charge reconciliation processes. Aligns with department/service line leadership and serves as the subject matter expert regarding the accuracy of charge capture processes including education, audit activities, changes or risk to revenue (regulatory or coding changes), and monitoring of charge capture-related metrics to minimize revenue leakage.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules

Revenue Integrity Specialist Responsibilities:

• Meets with department liaisons to review and interpret revenue cycle reports to drive accountability and transparency in performance;
• Works closely with Health Information Management (HIM), Clinical Documentation Improvement (CDI), Clinical Informatics, and Patient Financial Services (PFS) departments to resolve charge capture related issues;
• Identifies service line revenue trends and compiles information to determine quarterly focused reviews of specific departments;
• Develops an analytics structure that validates the accurate capture and reporting of charges, as well as identifies any issues present;
• Coordinates and manages Revenue Integrity and charge capture service line projects;
• Identifies and implements solutions that support more efficient and effective charge capture and reconciliation;
• Maintains knowledge of any CDM requests for the assigned department(s)/service lines(s) and support effective implementation and education;
• Assesses and validates revenue and usages and denials data and the root cause of any variances;
• Maintains knowledge of Electronic Health Record (EHR) reports and resources available to the RI team by working collaboratively with EHR IT;
• Participate actively in team development, achieving KPIs, and accomplishing department goals;
• Monitors charge review WQs and assists service line staff, as needed, to resolve and proactively prevent charging edits;
• Provides ongoing education support to department/service line staff on charge capture and charge reconciliation workflows.

Revenue Integrity Specialist Requirements:

• Education: Bachelor's Degree or 5 years of relevant experience instead of degree.
• Experience: 3 years Reimbursement General knowledge of healthcare revenue cycle including familiarity with reimbursement methodologies, coding, CDM, charge capture, and billing processes.

Revenue Integrity Specialist Preferred Requirements:

• Certification of CPC, CCS, RN, RHIA, or RHIT
• Proficiency in using revenue cycle management software, electronic health records (EHR), and practice management systems.
• Strong understanding of ICD-10, CPT, and HCPCS coding systems, including knowledge of modifiers and billing rules.
• Ability to analyze complex data, identify trends, and develop actionable insights to improve revenue cycle performance.
• Understanding of revenue cycle workflows and documentation requirements for compliance with federal, state, and payer-specific guidelines.