Revenue Integrity Specialist PB

Inova Health; Virginia (IL); On-site; USD 75,000 - 105,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plan with 5% company match

Tuition and student loan assistance

Mental health support for the team

Job summary

Inova Health is seeking a Revenue Integrity PB Specialist for a full-time day shift in Northern Virginia. The role focuses on accurate charge capture, compliant documentation, and timely billing across services, with cross-functional collaboration within the Revenue Cycle team.

The ideal candidate holds an associate degree in healthcare or finance, five years in coding or billing, and credentials such as RHIT/RHIA/CCS/CPC/CPC-H. Inova offers strong benefits and development opportunities.

Qualifications

• Associate Degree in a healthcare or finance related field.
• Five years of experience in either a coding or billing role.
• Credentials: RHIT, RHIA, CCS, CPC or CPC-H.

Responsibilities

• Ensure regulatory compliance for new and existing services and update CPT/HCPCS codes.
• Improve charge capture and documentation to substantiate charges and billing.
• Perform analytics, denials follow-up, and root-cause analysis for revenue integrity.
• Review denials trends and provide feedback to educate teams.
• Collaborate with HIM, CDI, and PFS to resolve charge capture issues.
• Validate medical necessity and ensure accurate claims processing.
• Support management with revenue cycle reporting and KPI achievement.

Skills

Charge capture

Billing

Coding knowledge

Analytics

Education

Associate Degree in healthcare or finance

Tools

EHR systems

Job description

Job Description

Inova 8095 - Fairfax East is looking for a dedicated Revenue Integrity PB Specialist to join the team. This role will be full-time day shift Monday – Friday, Business Hours -

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance: offeringupto $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off and paid parental leave.

Revenue Integrity PB Specialist Job Responsibilities

• Works with service line leaders to ensure regulatory compliance for new and existing services, implements charge capture process improvements and annual updates to CPT/HCPCS code selections.
• Collaborates with service lines, HIM, and other key stakeholders to improve charge capture, compliant documentation to substantiate charges, charge reconciliation, and compliant billing of all charges.
• Scope of work includes claim edits (CCI/LCD), follow-up denials, customer service/patient complaints, write-off requests, specialty projects, and training in charge entry. Ensures accurate and complete assignment of CPT/HCPCS codes, modifiers, and diagnoses that are supported by medical record documentation.
• Analyzes charge review findings and recommends to Revenue Cycle administration leadership in order to improve documentation, charging flow and accuracy.
• Reviews denial trends for documentation and charging opportunities and provides feedback on educational gaps.
• Performs appropriate analytics as daily work queue management functions are performed; performs verification of billing data for accuracy and completeness; and performs charge reviews by verifying billing data as compared to documentation and making corrections in patient accounting as needed.
• Partners with the Billing team counterparts to determine how claim errors related to coding or charge review are resolved for purposes of accurate billing of claims for payment.
• Reviews, monitors and resolves claims. Evaluates if account combinations and account splits are appropriately applied. Performs medical necessity validation required to ensure timely and accurate processing of claims.
• Reviews Inova Health System registration communications, applicable Centers for Medicaid & Medicare Services transmittals, National Coverage Decisions and Local Coverage Decisions.
• Reviews denial trends for documentation/charging opportunities and provides feedback on educational gaps.
• Provides support to manager to review and interpret revenue cycle reports to drive accountability and transparency in performance. Provides ongoing support to manager to improve service line charge capture and charge reconciliation workflows.
• Reviews analytics to validate accurate charge capture and reporting of charges; identify issues, perform root/cause analysis, and proposes solutions to manager. Reviews denials transferred from PFS team, analyzes root cause, corrects, or provides appeal support for claims as necessary and documents denials in tracker for trending analysis. Reviews Claim Edit WQs and proactively resolves and proposes solutions to prevent charging edits
• Works closely with Health Information Management (HIM), Clinical Documentation Improvement (CDI), Clinical Informatics, and Patient Financial Services (PFS) departments to resolve charge capture related issues.
• Maintains knowledge of any CDM requests for the assigned department(s)/service lines(s) and support effective implementation and education and maintains knowledge of Electronic Health Record (EHR) reports and resources available to RI team by working collaboratively with EHR IT.
• Participates actively in team development, achieving KPIs, and accomplishing department goals.
• May perform additional duties as assigned.

Minimum Qualifications

• Associate Degree in a healthcare or finance related field
• Five years of experience in either a coding or billing role.
• Credentials: one of the following coding credentials: AAPC/AHIMA: RHIT, RHIA CCS, CPC, CPC-H.

About Us

We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare.

Inova Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.