Revenue Integrity Specialist

Revenue Integrity Specialist

Position Overview

The Revenue Integrity Specialist is responsible for ensuring accurate charge capture, compliant billing practices, and optimal reimbursement within a Critical Access Hospital (CAH) setting. This role serves as a liaison between clinical departments, coding, billing, and finance to maintain the integrity of the revenue cycle while adhering to Medicare cost-based reimbursement regulations.

Essential Job Functions

• Review and validate charges to ensure accuracy, completeness, and proper documentation


• Identify, investigate, and resolve missing, duplicate, or incorrect charges


• Conduct routine and targeted audits across departments (e.g., lab, radiology, clinic, outpatient services)


• Monitor revenue cycle workflows and identify opportunities to improve charge capture and reduce revenue leakage


• Analyze denials and implement corrective actions to prevent recurrence


• Collaborate with coding, billing, clinical, and registration teams to resolve discrepancies


• Support Chargemaster (CDM) maintenance, including coding, pricing, and revenue code accuracy


• Ensure compliance with Medicare regulations, including Critical Access Hospital (CAH) requirements


• Provide education and guidance to staff on proper charge capture and documentation practices


• Assist in developing and improving revenue integrity policies, procedures, and workflows

Non-essential Job Functions

• Assist with special projects, reports, and revenue cycle initiatives as assigned


• Participate in committees, meetings, and process improvement efforts


• Provide cross-coverage or support for other revenue cycle functions as needed


• Assist with onboarding and training of new staff


• Support system upgrades, testing, and workflow implementations


• Prepare and present audit findings or educational materials to departments


• Maintain knowledge of industry trends, regulatory updates, and best practices


• Perform other duties as assigned

Requirements, Knowledge/Skills and Abilities

• Knowledge of Medicare regulations, including Critical Access Hospital (CAH) reimbursement methodologies


• Understanding of CPT/HCPCS coding, revenue codes, and billing processes


• Strong analytical and problem-solving skills with attention to detail


• Ability to identify trends, investigate discrepancies, and implement solutions


• Effective communication skills with the ability to educate and collaborate across departments


• Strong organizational and time management skills with the ability to manage multiple priorities


• Ability to work independently and maintain confidentiality of sensitive information


• Proficiency in Microsoft Office applications, especially Excel

Physical Demands and Working Conditions

• This position is Hybrid. The role requires prolonged periods of sitting, working at a computer, and performing repetitive tasks such as typing and data entry


• The position requires visual acuity to review detailed information on computer screens and the ability to communicate effectively via phone, video conferencing, and electronic communication.