Revenue Integrity Specialist

1 week ago


Valhalla, New York, United States WMC Health Full time
Job Summary

The Revenue Integrity Coordinator plays a critical role in ensuring the accuracy and completeness of charge capture and billing processes. This position requires a detail-oriented individual with a strong understanding of coding and billing regulations.

Key Responsibilities
  • Monitor and Resolve Issues: Identify pending charges and work to resolve issues in a timely manner.
  • Coding and Billing Expertise: Research coding errors, provide feedback to providers, and recommend sound billing and coding best practices.
  • Process Improvement: Foster continuous improvement of revenue cycle processes through education and trend analysis.
  • Claim Editing and Review: Identify pre-bill and post-bill claim edits involving clinical or coding review or required modifiers.
  • Billing System Management: Work within Cerner and SSI to correct billing issues and review billing/coding in additional EMRs.
  • Code Review and Compliance: Perform periodic review of codes and work with patient billing regarding bundling and unbundling services.
  • Technical Guidance: Research technical guidance in CPT/HCPCs Guide, CMS website, and Medicare Manuals to resolve billing issues and promote regulatory compliance.
  • Audit and Issue Tracking: Maintain and provide information on the status of audits and issues presented.
  • Special Projects: Work on special projects as required.
  • Regulatory Compliance: Participate in required regulatory change implementations and ongoing monitoring related to compliant charge capture.
Qualifications and Requirements
  • Experience: Minimum two years of clinical experience in a healthcare setting, with preferred experience in Excel and Electronic Medical Records.
  • Education: High School Diploma required, Associate's Degree preferred or two years' work experience.
  • Licenses/Certifications: Certified Professional Coder (CPC) or similar credential.
  • Other: Familiarity with medical record documentation standards and practices, healthcare insurance billing issues, and federal and state billing compliance issues for hospitals; knowledge of CPT-4 codes and ICD-10-CM codes is preferred.
About Us

WMC Health is a leading healthcare provider dedicated to delivering high-quality patient care and services. We offer a comprehensive compensation and benefits package that includes:

  • Health Insurance
  • Dental
  • Vision
  • Retirement Savings Plan
  • Flexible Savings Account
  • Paid Time Off
  • Holidays
  • Tuition Reimbursement


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