Revenue Integrity Specialist

North Florida Surgeons, P.A.; Jacksonville (FL); On-site; USD 60,000 - 90,000; Full time

Job summary

North Florida Surgeons, P.A. is seeking a Revenue Integrity Specialist to ensure accurate charge capture, coding, billing, and reimbursement across the organization.

You will serve as a liaison between clinical operations, patient financial services, coding, compliance, credentialing, and revenue cycle teams to identify leakage and improve reimbursement. You will conduct audits, analyze denials, review the CDM, and monitor service line charging for consistency.

Qualifications

• Associate's degree required.
• Bachelor's degree preferred in Healthcare Administration, Business Administration, Finance, or related field.

Responsibilities

• Conduct routine charge reconciliation and charge capture audits to identify missed, duplicate, or inaccurate charges.
• Investigate and resolve charge exceptions and revenue leakage opportunities.
• Analyze billing edits, claim denials, and reimbursement variances to identify root causes.
• Review charge master (CDM) and fee schedule accuracy and recommend updates.
• Monitor service line charging practices and ensure consistency across specialties.
• Validate provider documentation supports services rendered and billed.
• Collaborate with coding teams to identify documentation and coding opportunities.
• Review coding trends and reimbursement impacts.
• Ensure compliance with Medicare, Medicaid, commercial payer, and regulatory billing requirements.
• Monitor regulatory updates impacting billing, coding, and reimbursement.
• Assist with internal compliance audits and corrective action plans.
• Prepare revenue integrity reports and dashboards.
• Track key performance indicators including: charge lag, charge capture rates, revenue leakage, denial rates, underpayments, net collection rates.
• Analyze trends and present findings to leadership.
• Identify denial trends related to registration, authorization, coding, and charge entry.
• Collaborate with operational departments to implement preventive measures.
• Support recovery efforts for underpayments and missed billing opportunities.
• Educate providers and staff regarding documentation, charging, coding, and reimbursement requirements.
• Develop training materials and job aids.
• Participate in onboarding and ongoing educational programs.
• Work closely with: Revenue Cycle Management, Coding, Compliance, Clinical Departments, Credentialing, Contracting, Information Technology, Managed Care.

Education

Associate's degree

Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field preferred

Job description

The Revenue Integrity Specialist is responsible for ensuring the accuracy, compliance, and optimization of charge capture, coding, billing, and reimbursement processes across the organization. This position serves as a liaison between clinical operations, patient financial services, coding, compliance, credentialing, and revenue cycle teams to identify revenue leakage, improve reimbursement, and maintain regulatory compliance.

Essential Duties and Responsibilities

Revenue Integrity & Charge Capture

• Conduct routine charge reconciliation and charge capture audits to identify missed, duplicate, or inaccurate charges.
• Investigate and resolve charge exceptions and revenue leakage opportunities.
• Analyze billing edits, claim denials, and reimbursement variances to identify root causes.
• Review charge master (CDM) and fee schedule accuracy and recommend updates.
• Monitor service line charging practices and ensure consistency across specialties.
• Validate provider documentation supports services rendered and billed.

Coding & Compliance Support

• Collaborate with coding teams to identify documentation and coding opportunities.
• Review coding trends and reimbursement impacts.
• Ensure compliance with Medicare, Medicaid, commercial payer, and regulatory billing requirements.
• Monitor regulatory updates impacting billing, coding, and reimbursement.
• Assist with internal compliance audits and corrective action plans.

Data Analysis & Reporting

• Prepare revenue integrity reports and dashboards.
• Track key performance indicators including:
  • Charge lag
  • Charge capture rates
  • Revenue leakage
  • Denial rates
  • Underpayments
  • Net collection rates
• Analyze trends and present findings to leadership.

Denial Prevention & Recovery

• Identify denial trends related to registration, authorization, coding, and charge entry.
• Collaborate with operational departments to implement preventive measures.
• Support recovery efforts for underpayments and missed billing opportunities.

Provider and Staff Education

• Educate providers and staff regarding documentation, charging, coding, and reimbursement requirements.
• Develop training materials and job aids.
• Participate in onboarding and ongoing educational programs.

Cross-Functional Collaboration

• Work closely with:
  • Revenue Cycle Management
  • Coding
  • Compliance
  • Clinical Departments
  • Credentialing
  • Contracting
  • Information Technology
  • Managed Care

Qualifications

Education

• Associate's degree required.
• Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field preferred.

Experience

• 3-5 years of healthcare revenue cycle experience.
• Experience with physician practice operations, coding, charging, billing, or denial management.
• Multi-specialty physician group experience preferred.

Certifications Preferred

• CPC
• CPMA
• COC
• CRC
• RHIT
• RHIA

Knowledge, Skills, and Abilities

• Strong understanding of physician and facility revenue cycle processes.
• Knowledge of CMS regulations and payer guidelines.
• Advanced Excel and reporting capabilities.
• Strong analytical and problem-solving skills.
• Excellent communication and presentation skills.
• Ability to manage multiple priorities independently.