Revenue Integrity Specialist

Job Summary

A company is looking for a Revenue Integrity Specialist responsible for processing reimbursement/payment audits and maximizing cash flow.

Key Responsibilities

• Audit provider and care center information for accuracy and compliance
• Ensure accurate reimbursement by auditing payer-processed claims according to contracts and government rates
• Identify and manage denial trends while collaborating with Revenue Cycle Teams and payer representatives

Required Qualifications

• High School Graduate
• Advanced skills in Microsoft Excel (e.g., pivot tables, VLOOKUP)
• 3+ years of experience with payer contracts and/or auditing payments
• Strong understanding of fee schedules and claims payment processes
• Experience with Trizetto EOB resolve tool or similar contract management software preferred