Senior Authorization & Revenue Integrity Specialist

Capital Health (US); Lawrenceville (NJ); On-site; USD 74,235 - 96,990; Full time

Benefits offered by this job

Medical Plan

Dental Plan

Vision Plan

Retirement Savings Plan

Paid Time‑Off Program

Job summary

Capital Health is seeking a Revenue Integrity Authorization Specialist to ensure accurate pre-bill controls and timely corrections for high-risk accounts. You will verify payer details, CPT/HCPCS codes, and service alignment with authorizations.

The role requires strong analytical skills, experience with payer portals, and proficiency in EHR/revenue cycle tools. RN background is preferred, with a focus on preventing claim denials and ensuring compliant billing processes.

Qualifications

• Education: High school diploma or equivalent. RN license preferred. Certification or license in surgical or diagnostic procedures.
• Experience: Three years’ hospital revenue cycle, prior authorization, patient access financial clearance, or related experience. Experience with payer portals and authorization workflows required.
• Knowledge: Payer authorization requirements including CPT/HCPCS, units, date range, site of service, and level of care dependencies.

Responsibilities

• Perform pre-service authorization integrity review for scheduled high-risk accounts to confirm authorization is present, valid, and aligned with planned services.
• Verify authorization elements including payer, CPT/HCPCS, diagnosis linkage, units, date span, rendering/facility, and site/setting.
• Perform post-procedure pre-bill authorization validation by comparing final services performed to authorization approvals and identify mismatches prior to claim release.
• Initiate timely correction workflows with Central Scheduling, physician offices, and clinical departments; escalate unresolved high-risk accounts.

Skills

Analytical thinking

Attention to detail

Communication

Payer portals

Excel

EHR/Revenue cycle platforms

Education

High school diploma

RN license preferred

Certification or license in surgical/diagnostic procedures

Tools

EHR/revenue cycle platforms

Payer portals

Job description

Capital Health is seeking a Revenue Integrity Authorization Specialist to ensure accurate pre-bill controls and timely corrections for high-risk accounts. You will verify payer details, CPT/HCPCS codes, and service alignment with authorizations.

The role requires strong analytical skills, experience with payer portals, and proficiency in EHR/revenue cycle tools. RN background is preferred, with a focus on preventing claim denials and ensuring compliant billing processes.