Revenue Integrity Specialist - Remote

Overview

The Revenue Integrity Specialist is responsible for processing reimbursement/payment audits, ensuring compliance with policies and contracts, and maximizing cash flow through effective auditing practices.

In Short

• Conduct audits to ensure accurate provider and care center information.
• Verify reimbursement accuracy per payer contracts.
• Perform Care Center audits post-implementation.
• Lead initiatives to drive efficiency in revenue optimization.
• Make independent decisions on audit results.
• Manage denial trends and collaborate with Revenue Cycle Teams.
• Assist with Trizetto/Cognizant setup.
• Work with Salesforce cases and athenaOne tables.
• Adhere to escalation processes for issue resolution.
• Perform additional duties as assigned.

Requirements

• High School Graduate.
• Advanced Microsoft Excel skills.
• 3+ years of experience with payer contracts and auditing.
• Strong understanding of fee schedules and claims payment.
• Analytical skills to identify payment variances.
• Experience with Trizetto EOB resolve tool preferred.
• 3+ years in a medical billing office preferred.
• Experience with athenaOne software preferred.
• Compliance with HIPAA regulations.

Benefits

• Base salary of $60,000.00 - $65,000.00.
• Annual bonus targeted at 10%.
• Medical, dental, and vision insurance.
• Life and pet insurance.
• 401K plan.
• Paid time off.
• Wellness programs.