Revenue Integrity Authorization Specialist

3M HEALTHCARE; Princeton (NJ); On-site; USD 102,266,136 - 134,158,953; Full time

Benefits offered by this job

Medical Plan

Prescription drug coverage & In-House

Dental Plan

Vision Plan

FSA – Healthcare/ Dependent Care

Retirement Savings

AD&D Insurance

Paid Time-Off

Job summary

Capital Health is seeking a Revenue Integrity Specialist to ensure proactive authorization controls before billing. The role involves pre-service verification for high-risk accounts and post-procedure pre-bill validation to align services with approvals, working with Central Scheduling, clinical departments, and payer portals.

Candidates should have a background in hospital revenue cycle, strong analytical skills, and experience with EHR and Excel.

Qualifications

• High school diploma or equivalent; RN license preferred.
• Three years’ hospital revenue cycle or related experience.
• Experience with payer portals and authorization workflows.

Responsibilities

• Performs pre-service authorization integrity review for scheduled high-risk accounts.
• Verifies authorization elements: payer, CPT/HCPCS, units, date span, site/setting.
• Performs post-procedure pre-bill validation and reconciles with approvals.
• Identifies and resolves variances such as missing authorization or incorrect CPT.
• Initiates timely correction workflows with scheduling, physicians, and departments.
• Communicates with downstream billing and follow-up teams; tracks defects.

Skills

Payer authorization knowledge

Analytical skills

Detail oriented

Communication skills

Education

High school diploma or equivalent

RN license preferred

Tools

EHR systems

Payer portals

Excel

Job description

Capital Health is seeking a Revenue Integrity Specialist to ensure proactive authorization controls before billing. The role involves pre-service verification for high-risk accounts and post-procedure pre-bill validation to align services with approvals, working with Central Scheduling, clinical departments, and payer portals.

Candidates should have a background in hospital revenue cycle, strong analytical skills, and experience with EHR and Excel.