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Revenue Integrity Specialist
Req #: 0000270070
Category: Revenue Cycle and Patient Access
Status: Full-Time
Shift: Day
Facility: RWJBarnabas Health Corporate Services
Department: Revenue Integrity
Pay Range: $76,200.00 - $95,300.00 per year
Location:
2 Crescent Place, Oceanport, NJ 07757
Job Title: Revenue Integrity Specialist
Location: System Business Office
Department Name: Revenue Integrity
Req #: 0000270070
Status: Salaried
Shift: Day
Pay Range: $76,200.00 - $95,300.00 per year
Pay Transparency:
The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.
The compensation offered to the candidate selected for the position will depend on several factors, including the candidates educational background, skills and professional experience.
Job Summary:
As the Revenue Integrity Specialist, you will assist the Revenue Integrity Manager in performing daily tasks. The specific tasks for this process include, but are not limited to, the following:
- Coordinate Quarterly and Annual Code Updates
- Charge Master Maintenance
- Monitors for Regulatory changes
- Supports clinical department & physician practice / new service line development
- Audit and monitoring
- Multidisciplinary Team Collaboration
- Promote efficiencies
- Epic Work Queue Oversight
As a Revenue Integrity Specialist, a typical day might include:
- Maintain up-to-date knowledge of all CMS & AMA publications as it pertains to code additions, revisions and deletions to share with appropriate clinical departments for education & compliance purposes. Responsible for coordinating and validating updates to charge capture tools, ensuring regulatory compliance and identifying CPT code and fee schedule updates, while keeping clinical and financial builds accurate.
- Maintain CDM accuracy by reviewing naming, revenue codes, CPT/HCPCS, modifiers, pricing, and cost fields while coordinating with billing and supply teams to confirm chargeability, correct codes, and compliance update.
- Initiate and authorize charges and respond promptly to revenue integrity supply requests.
- Monitors regulatory changes from CMS, then coordinates with PB education, charge build updates, and communications across IT, billing, compliance, and managed care to keep charging and contracts compliant.
- Provides support to help departments understand charge reconciliation tools and expectations while working with coding and revenue integrity to keep charging compliant and efficient.
- Reviews new services, helps set up departments properly, and ensures charges are set correctly, and posted accurately after go-live.
- Develop and submit an annual service line audit plan to the Revenue Integrity Manager and conduct routine reviews of assigned specialty charge capture using reconciliation and reporting tools to ensure accurate CPT coding, modifiers, quantities, and revenue integrity.
- Audit unlisted CPT code usage, validate claim system controls, collaborate with department leaders as needed, and provide findings and recommendations to improve compliance and charge capture accuracy.
- Collaborate with multidisciplinary teams to evaluate operational and IT changes, ensure compliant charge capture and documentation, support charge testing and monitoring, and provide timely guidance and recommendations to optimize revenue integrity and financial performance.
- Analyze trends in edits and work queues to identify root causes, recommend and implement approved revenue integrity and charge compliance improvements with clinical and IT collaboration, and communicate resulting changes to impacted staff.
- Ensure daily review and resolution of all Revenue Integrity owned work queues as assigned (Account, Charge, and Claim Work Queues).
- Perform Special Projects for the Manager/Assistant Vice President of Revenue Integrity and other duties as assigned.
This role might be for you if you have the following qualities:
- Provides a compassionate and supportive environment with prompt and consistent service.
- Adheres to patient rights: provides for the confidential treatment of all communications and records.
- Demonstrates professionalism with families, visitors, physicians, co-workers and supervisors.
- Supports teamwork by cooperative problem-solving through participation in meetings, projects, etc.
- Utilizes principles of continuous quality improvement in all work situations to assess, measure and improve organizational and department functions.
- Organize work, and set priorities with a minimum of supervision, seeks guidance as appropriate.
- Makes decisions that are timely and consistent with the departments objectives, policies and procedures.
- Demonstrates sound judgment; accepts and benefits from constructive criticism
To be considered for this opportunity, you must meet the following requirements:
- HS Diploma or equivalent
- Bachelor's Degree (BA or BS) in business, finance or a healthcare related field preferred
- Preferred Certifications & Licenses: Registered Nurse (RN), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)
- Possess effective oral and written skills. Ability to interpret and implement regulatory standards.
- Demonstrated success performing CDM reviews, CPT/HCPCS coding expertise, billing and reimbursement knowledge. ICD-10 coding knowledge.
- Epic experience preferred
Why You'll Love Working Here:
At RWJBarnabas Health, our people are at the center of everything we do. Through our Total Wellbeing promise, we offer a wide range of benefits and resources to support your physical, emotional, financial, and professional wellbeing. Highlights include:
- Generous Paid Time Off (Vacation, Holidays, Sick Time)
- Medical, Dental & Vision Insurance
- Prescription Drug Coverage
- Retirement Plans
- Paid Parental Leave
- Tuition Reimbursement
- Student Loan Planning Support
- Life and Disability Insurance
- Wellness Programs and Flexible Spending Accounts
- Voluntary Benefits (like Pet Insurance)
- Discounts with local partners (e.g., NJ Devils, NJPAC, Verizon)
- Community involvement and volunteer opportunities …and more!
Why RWJBarnabas Health:
RWJBarnabas Health is New Jersey's largest and most comprehensive academic health system, committed to delivering exceptional care and creating healthier communities. We're proud to offer a workplace that values compassion, equity, and innovation-where every team member plays a vital role. When you join us, you're not just building a career-you're helping to shape the future of healthcare, one person and one community at a time.
At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees physical, emotional, social, and financial health.
- Paid Time Off (PTO)
- Medical and Prescription Drug Insurance
- Dental and Vision Insurance
- Retirement Plans
- Short & Long Term Disability
- Life & Accidental Death Insurance
- Tuition Reimbursement
- Health Care/Dependent Care Flexible Spending Accounts
- Wellness Programs
- Voluntary Benefits (e.g., Pet Insurance)
- Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!
RWJBarnabas Health is an Equal Opportunity Employer
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