Revenue Integrity Specialist

Overview

A technology-driven national physician enablement organization is seeking a Revenue Integrity Specialist to support reimbursement and payment audit processes. This role involves ensuring accurate and timely processing of audits in compliance with policies, payer contracts, and government fee schedules. The specialist will collaborate with operations consultants, revenue cycle management accounts receivable staff, and management to maximize cash flow and track audit outcomes.

Responsibilities

• Audit systems to verify accuracy of new provider and care center information
• Ensure reimbursement accuracy per payer contract agreements and government/state rates by auditing processed claims
• Conduct Care Center audits based on provider count at 30/60/90/120 days post implementation or go-live
• Assist leadership in initiatives to improve efficiency and collaborate with internal teams and commercial payers
• Make independent decisions on audit results and communicate with contract negotiators, senior leaders, market leaders, or payers to optimize revenue
• Follow approved escalation processes for timely issue resolution and completion of action plans
• Identify and manage denial management trends; collaborate with revenue cycle teams and payer representatives
• Create reference tools on payer policies
• Assist with Trizetto/Cognizant setup and fee schedule configuration
• Manage Salesforce cases and athenaOne tables
• Perform other duties aligned with key performance and department goals

Requirements

• High school diploma or equivalent
• Advanced Microsoft Excel skills (pivot tables, VLOOKUP, sorting/filtering, formulas)
• Minimum 3 years experience with payer contracts and/or auditing payer payments
• Strong understanding of fee schedules and claims payment processes
• Analytical skills to identify payment variances, resolve payment issues, and analyze payer information and policies
• Experience with Trizetto EOB resolve tool or equivalent contract management software
• Preferred: 3+ years experience in a medical billing office
• Preferred: Experience with athenaOne software system
• Must comply with HIPAA regulations

Compensation & Benefits

• Base salary range: $55,000 to $60,000 annually, exclusive of bonuses and benefits
• Eligible for an annual bonus targeted at 10%
• Benefits include medical, dental, vision, life and pet insurance, 401(k), paid time off, and wellness programs
• Base pay will be determined based on experience, education, and geographic location

Additional Information

• Confidentiality maintained according to EEO guidelines
• For remote workers: minimum internet speed of 5 Mbps download and 3 Mbps upload required prior to employment
• Employees working from home offices may be eligible for expense reimbursement related to internet costs

Location

• This position may be remote or onsite depending on organizational needs