Revenue Integrity Specialist
Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.
Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.
The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).
$44.37 - $57.97
Scheduled Weekly Hours: 40
Position Overview
Responsible for pre-bill revenue protection for surgical and procedural encounters, with primary focus on implant, device, and high-cost supply/drug-supported cases. Performs detailed reconciliation of clinical and financial records to ensure complete and accurate charge capture before claim finalization. Reviews physician operative/procedural reports, implant/device logs, purchasing documentation, and billing detail to identify missing invoices, missing charges, documentation-to-charge mismatches, and related claim-readiness risks. Supports trailer billing workflows by obtaining and validating implant/device invoice support and routing corrections to the appropriate operational teams. This role is part of Revenue Integrity and collaborates with OR/Cath/IR departments, Purchasing/Supply Chain, Pharmacy, Patient Financial Services, and HIM/Coding as needed.
Minimum Requirements
Education: High school diploma or equivalent required. Associate degree in healthcare, nursing, health information, business, or related field preferred.
Experience: Three years' hospital revenue cycle, charge capture, surgical billing support, OR/Cath/IR account review, or related experience required. Experience reconciling operative documentation, implant/device records, and pre-bill accounts required. Experience with surgical/procedural case workflows (OR, Cath Lab, IR, Endo, etc.) strongly preferred. Registered Nurse (RN) license preferred, not required. Non-RN candidates must demonstrate strong competency in interpreting operative/procedural documentation for charge integrity purposes.
Other Credentials: Knowledge and Skills: Strong understanding of hospital charge capture and pre-bill controls for surgical/procedural services. Working knowledge of CPT/HCPCS, modifiers, revenue codes, and unit-based charging concepts. Ability to interpret physician operative/procedural reports and correlate to billable services and implant/device usage. Strong analytical, organizational, and follow-up skills in high-volume, time-sensitive workflows. Effective communication skills with clinical and non-clinical teams.
Special Training: Proficiency with EHR/revenue cycle systems, account work queues, and case tracking tools. Proficiency in Excel and standard reporting tools.
Mental, Behavioral and Emotional Abilities: Usual Work Day: 8 Hours Reporting RelationshipsDoes this position formally supervise employees? No
If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.
Essential Functions
Performs pre-bill surgical revenue integrity review for designated accounts, prioritizing implant/device/high-dollar procedural encounters.
Reviews and interprets physician operative/procedural reports to validate that services performed are accurately reflected in pre-bill charging records.
Reconciles implant/device/supply usage across operative documentation, implant logs, supply chain/purchasing records, and account-level charge detail.
Supports trailer billing workflows by obtaining, validating, and routing implant/device invoice support to appropriate teams for compliant claim submission.
Identifies and documents defects including missing implant invoice, implant not billed, missing OR/procedural charges, under-coded units, and documentation-to-charge mismatch.
Coordinates with OR/Cath/IR leadership, Purchasing/Supply Chain, Pharmacy, and billing teams to resolve identified issues before claim release.
Applies hold/release standards for unresolved high-risk surgical accounts and escalates per policy to protect filing timeliness and revenue.
Initiates and tracks correction requests through established correction pathways and ensures closure of issues.
Documents account findings, issue category, root cause, action taken, and final disposition in designated Revenue Integrity tools/trackers.
Identifies recurring defect trends by facility, service line, physician, procedure, or workflow and escalates systemic issues to Revenue Integrity leadership.
Participates in daily/weekly Revenue Integrity operations huddles and contributes to standard work improvements.
Escalates clinically ambiguous documentation scenarios to RN leadership per defined escalation standards.
Supports onboarding, cross-training, and maintenance of workflow documentation as assigned.
Performs other duties as assigned.
Physical Demands and Work Environment
Frequent physical demands include: Sitting, Wrist position deviation, Pinching/fine motor activities, Keyboard use/repetitive motion, Talk or Hear
Occasional physical demands include: Standing, Walking, Climbing (e.g., stairs or ladders), Carry objects, Push/Pull, Twisting, Bending, Reaching forward, Reaching overhead, Squat/kneel/crawl
Continuous physical demands include:
Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.
Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Moderate Depth Perception, Moderate Hearing
Anticipated Occupational Exposure Risks Include the following: N/A
This position is eligible for the following benefits:
- Medical Plan
- Prescription drug coverage & In-House Employee Pharmacy
- Dental Plan
- Vision Plan
- Flexible Spending Account (FSA)
- Healthcare FSA
- Dependent Care FSA
- Retirement Savings and Investment Plan
- Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
- Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
- Disability Benefits Long Term Disability (LTD)
- Disability Benefits Short Term Disability (STD)
- Employee Assistance Program
- Commuter Transit
- Commuter Parking
- Supplemental Life Insurance
- Voluntary Life Spouse
- Voluntary Life Employee
- Voluntary Life Child
- Voluntary Legal Services
- Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
- Voluntary Identity Theft Insurance
- Voluntary Pet Insurance
- Paid Time-Off Program
The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.
The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.
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