Revenue Integrity Specialist

Revenue Integrity Specialist – Home Infusion Pharmacy Position Summary The Revenue Integrity Specialist is responsible for ensuring the accuracy, compliance, and optimization of revenue cycle processes within a home infusion pharmacy environment. This role serves as a bridge between intake, clinical operations, billing, reimbursement, and payer relations to ensure services are appropriately authorized, documented, billed, and reimbursed. The Revenue Integrity Specialist identifies revenue leakage, monitors billing compliance, analyzes denials, and drives process improvements that enhance financial performance while maintaining regulatory compliance. This position reports directly to the Manager of Revenue Cycle for Therapeutic Solutions Vital Care’s multi-site network. Review billing practices to ensure accurate charge capture and reimbursement. Conduct audits of patient accounts, claims, and documentation to identify revenue leakage. Validate compliance with Medicare, Medicaid, commercial payer, and PBM billing requirements. Collaborate with operational teams to address billing and documentation deficiencies. Analyze denied, underpaid, and unpaid claims to identify root causes and trends. Work with billing teams to resolve complex reimbursement issues. Ensure accurate coding, billing, and reimbursement for infusion therapies and related services. Partner with intake, prior authorization, nursing, pharmacy, and billing teams to optimize workflows. Serve as a subject matter expert on reimbursement and payer-related issues. Qualifications Required High school diploma or equivalent. 3+ years of experience in healthcare revenue cycle, medical billing, or reimbursement. Experience with Medicare, Medicaid, commercial insurance, and specialty pharmacy billing. Strong understanding of denial management and reimbursement methodologies. Proficiency with healthcare billing systems and Microsoft Excel. Strong analytical and problem-solving skills. Preferred Experience in home infusion, specialty pharmacy, or ambulatory infusion services. Certified Revenue Cycle Representative (CRCR) or similar certification. Experience with payer contracting and reimbursement strategy. Associate’s or Bachelor’s degree in Healthcare Administration, Business, Finance, or related field. #J-18808-Ljbffr