Revenue Integrity Specialist

Vital Care of Greenville and Healthwise Pharmacy of Greenville, Inc.; Greenville (NC); On-site; USD 65,000 - 90,000; Full time

Job summary

Vital Care of Greenville and Healthwise Pharmacy of Greenville, Inc. seeks a Revenue Integrity Specialist to ensure accurate charge capture, compliant billing, and optimized revenue cycles in a home infusion setting.

You will bridge intake, clinical operations, billing, reimbursement, and payer relations to ensure services are properly authorized and reimbursed. Responsibilities include auditing patient accounts, addressing denials, collaborating across teams, and serving as a subject matter

Qualifications

• 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.

Responsibilities

• 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.

Skills

Revenue cycle expertise

Denial management

Healthcare billing systems

Analytical skills

Problem solving

Education

High school diploma or equivalent

Associate’s or Bachelor’s degree in Healthcare Administration, Business, Finance, or related field

Tools

Microsoft Excel

Job description

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.