Revenue Integrity Specialist

Position Overview

Be a part of a world‐class academic healthcare system, UChicago Medicine, as a Revenue Integrity Specialist in the Revenue Cycle department. This primarily work‐from‐home role (with onsite requirements as needed) focuses on improving compliant and accurate billing and charge capture to decrease costly back‐end work and optimize cash flow. You will collaborate with clinical staff, service line leadership, coding teams, IT, and other revenue cycle departments.

Key Responsibilities

• Implement and promote consistent revenue integrity practices in compliance, coding, billing, and proper documentation.
• Optimize reimbursement by partnering with various departments to enhance the revenue stream and documentation processes.
• Analyze and assist with the correction of billing and coding errors identified by pre‐billing edits to prevent claim delays, denials, and non‐compliant billing.
• Mitigate external audit risks through regular audits and continual educational efforts.
• Monitor revenue volumes, claim edits, and late charges, providing real‐time notifications of unusual variances.
• Advise on proper revenue cycle processes and workflows, assisting departments in resolving errors that hinder timely and accurate claim submissions.
• Manage regulatory content to simplify the complex reimbursement environment and support operational efficiencies.
• Help departments maximize revenue when new CPT codes or changes in payment rates occur.
• Provide guidance for correcting billholds and coding errors to ensure compliant and accurate claims submission.
• Conduct concurrent and retrospective audits focusing on coding, billing, and documentation, with follow‐up education as needed.
• Review revenue performance and monitor charge capture using tools such as Revenue Guardian to identify opportunities for improvement.
• Identify regulatory changes affecting billing practices and assist in developing new procedures in response.
• Develop and conduct targeted training on revenue cycle processes, including billing, coding, and compliance.
• Analyze denial trends and implement plans—including automation and template creation—to reduce future denials.

Required Qualifications

• High school diploma required; Associate or Bachelor's degree in healthcare information or healthcare finance preferred.
• Proven working knowledge of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding systems; auditing experience is a plus.
• Knowledge of Federal billing regulations for Medicare and Medicaid and familiarity with managed care and indemnity payor requirements.
• Working knowledge of Local and National Coverage Determination policies, APC-related edits (e.g., NCCI, OCE), and HIPAA regulations.
• Proficient in Microsoft Excel, Word, PowerPoint, with some familiarity with Access.
• Highly analytical with excellent written, verbal communication and organizational skills.
• Health Information Management or Coding certification required at the time of hire (e.g., RHIA, RHIT, CPC, CCS, CCS-P, or CCA); HIA students may be considered within three months of hire.

Preferred Qualifications

• Working knowledge of oncology and/or allied health services (such as genetic counseling, dietetics, or social work) is preferred.

Benefits & Perks

• Compensation: Transparent pay range based on current market data and candidate qualifications, reviewed annually.
• Benefits: Access to a comprehensive package including health, dental, vision, retirement plans, and more (for eligible roles).
• Enjoy a positive work environment with career development and continuous learning opportunities.