Revenue Integrity Specialist

About the role

The Revenue Integrity Specialist performs complex internal analysis of denials and supports corrective actions across Covenant Health entities. Working under supervision with significant independence, the role ensures compliance with payer rules and drives revenue recovery.

Key responsibilities

• Review ADR logs, denial management reports, and payer websites to identify and address denial issues.
• Research and analyze denials related to charges, CPT coding, modifiers, and billing processes to recover reimbursement.
• Prepare and package appeals for ALJ, Independent Review, and Binding Arbitration, and maintain payor issue lists.
• Coordinate with vendors, third‑party payors, and internal teams to resolve over‑payments, under‑payments, and billing discrepancies.
• Document denial activities, report statistics, and develop compliant workflows for third‑party vendors.
• Support special projects and collaborate with financial analysts, auditors, and physician advisors on root‑cause analysis.

Required profile

• Associate or Bachelor’s degree in HIM, Coding, Finance, Business, or Healthcare.
• Minimum three years of experience in healthcare billing and revenue cycle analysis.
• Strong knowledge of Medicare/Medicaid guidelines and third‑party payer regulations.

Required skills

• Proficiency with PC, Windows operating system, Microsoft Excel, and Word processing.