Revenue Integrity Specialist

Job Title: 

Revenue Integrity Specialist

Job Location:

Merrimack, NH

Job Description:

Objective: Improve accurate and clean claim billing. Reduce AR denial percentage by leveraging software rules engine for correct coding. Optimize automation in software rules engine for less touches of claims prior to going to clearing house. To work closely with AR, Operations and Account Managers to develop rules and educate clients. Assist in helping develop best practices for both PRL and clients.

Job Responsibilities:

  • The Director of Revenue Integrity would hire and develop team.

  • Create and implement achievement goals and monitor progress.

  • Asses each member of the team to ensure we have A players in place and make any necessary changes

  • Review denials and write new edits (Coordinate with AR, Operations, Account Managers and EDI)

  • Review all edits to ensure proper functioning and see if any can be automated

  • Quarterly quality checks or team member

  • Monitor targets on a daily basis

  • Review software engine reports daily, monthly and provide feed back to Account Managers and Operations

The position will also be responsible for identifying task trends and provide feedback to Coding, AR, Account Managers and Operations. Reviewing CPT and ICD-10 coding edits. Review monthly newsletters from insurances for any policy changes and update existing rules in RCX. Being able to maneuver in web sites, various EMR systems and utilizing on-line resources.


Competencies Needed

  • Attention to detail

  • Strong Typing skills.

  • ICD-10 and CPT coding experience

  • Coding certification through AAPC or AHIMA preferred

  • Ability to work within a team or independently.

  • Allscripts Practice Management (Ntierprise) knowledge a plus

  • Verbal and written communication skills

  • Ability to respond to questions in a tactful and professional manner.

  • Ability to operate computers and various software programs

  • Ability to perform in a fast-paced environment

  • Ability to maintain confidentiality

  • Ability to multi-task


  • HS+ degree

  • 3+ years of medical experience

The position is full time and includes dental, health, and life insurance. Paid vacation and holidays and other various benefits. Salary is negotiable.

Job Type: