Surgical Revenue Integrity Specialist | Pre-Bill & Implants

Capital Health (US); New York (NY); On-site; USD 61,000 - 80,000; Full time

Benefits offered by this job

Medical Plan

Prescription drug coverage

Dental Plan

Vision Plan

Flexible Spending Account

Retirement Savings Plan

Group Life Insurance

Paid Time-Off Program

Job summary

Capital Health is seeking a Revenue Integrity – Pre-bill Specialist to review designated accounts before billing, focusing on implants, devices, and high-cost supplies. You will validate documentation against charges and coordinate with OR, Purchasing, Pharmacy, and Billing teams to ensure clean claim submission.

The role requires 3+ years in hospital revenue cycle, strong analytical skills, and proficiency with CPT/HCPCS and Excel. RN preferred but not required; 40-hour work week on-site.

Qualifications

• Education: Associate degree preferred; high school diploma required.
• Three years’ hospital revenue cycle, charge capture, or related experience required.
• Experience reconciling operative documentation, implant/device records, and pre-bill accounts required.
• Experience with surgical/procedural case workflows (OR, Cath Lab, IR, Endo) preferred.

Responsibilities

• Performs pre-bill surgical revenue integrity review for designated accounts, prioritizing implant/device/high-dollar encounters.
• Reviews physician operative/procedural reports to validate services reflected in pre-bill charging records.
• Reconciles implant/device/supply usage across documentation and account-level charge detail.
• Supports trailer billing workflows by obtaining and routing implant/device invoice support.
• Documents defects and coordinates with leadership to resolve issues before claim release.
• Escalates clinically ambiguous documentation to RN leadership as needed.

Skills

Analytical skills

Organizational skills

Follow-up skills

Excel proficiency

Communication skills

CPT/HCPCS knowledge

Revenue codes knowledge

Education

Associate degree in healthcare, nursing, health information, business, or related field

High school diploma or equivalent

Tools

EHR systems

Revenue cycle systems

Case tracking tools

Job description

Capital Health is seeking a Revenue Integrity – Pre-bill Specialist to review designated accounts before billing, focusing on implants, devices, and high-cost supplies. You will validate documentation against charges and coordinate with OR, Purchasing, Pharmacy, and Billing teams to ensure clean claim submission.

The role requires 3+ years in hospital revenue cycle, strong analytical skills, and proficiency with CPT/HCPCS and Excel. RN preferred but not required; 40-hour work week on-site.