Oncology Revenue Integrity Expert

Southwest General; Middleburg Heights (OH); On-site; USD 65,000 - 90,000; Full time

Job summary

Southwest General Health Center in Middleburg Heights, OH, is seeking a Revenue Integrity Specialist to ensure accurate charge capture, billing and adjudication for oncology services, including infusion, injections, diagnostics and radiation therapy.

The role acts as a liaison between providers, patients and the revenue cycle team to verify insurance requirements, support authorizations and minimize denials while maintaining compliance with medical necessity criteria and payer policies.

Qualifications

• Associate degree required; bachelor's preferred.
• Experience with Medicare, Medicaid and commercial plans.
• 3–5 years in oncology billing or revenue cycle.
• Knowledge of payer policies and medical necessity.
• CCS or Utilization Review certification preferred.

Responsibilities

• Facilitate charge capture, billing and adjudication for oncology services.
• Review treatment plans against payer guidelines and manage authorizations/appeals.
• Coordinate with providers, patients and revenue cycle teams to ensure compliant reimbursement.
• Monitor insurance requirements and ensure timely documentation and verification.

Skills

Oncology billing

Prior authorization

Medical necessity

Payer reimbursement

Revenue cycle

Utilization management

Clinical documentation

Insurance knowledge

Education

Associate degree

Bachelor's degree preferred

CCS certification preferred

Job description

Southwest General Health Center in Middleburg Heights, OH, is seeking a Revenue Integrity Specialist to ensure accurate charge capture, billing and adjudication for oncology services, including infusion, injections, diagnostics and radiation therapy.

The role acts as a liaison between providers, patients and the revenue cycle team to verify insurance requirements, support authorizations and minimize denials while maintaining compliance with medical necessity criteria and payer policies.