Job Details
Support Services | Miamisburg | Full-Time | First Shift
Responsibilities & Requirements
The Revenue Integrity Specialist ensures accurate and compliant charge capture, billing, and reimbursement processes to optimize the healthcare revenue cycle and support organizational financial health. This role bridges clinical and financial operations by monitoring compliance, analyzing data, and collaborating with departments to resolve revenue-related issues. Performs other duties as assigned. All job responsibilities are to be carried out in alignment with Kettering Health's mission, vision, values, and B Safe program.
Required Education
- High School Diploma or GED required.
- Equivalent work experience in revenue cycle operations, billing, or coding may be considered in lieu of formal education.
Required Work Experience
- Minimum of 2 years of experience in medical billing, coding, or revenue cycle operations in a healthcare setting.
Required Licenses, Certifications, and Registrations
- None required on day one; however, certification as a Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Registered Health Information Technician (RHIT), Registered Health EFFECTIVE DATE 08/16/2026 Information Administrator (RHIA), or Certified Coding Specialist (CCS) is typically expected within 12 months of hire.
Skills
- Proficiency in ICD-10, CPT, and HCPCS coding systems
- Strong analytical and problem-solving skills
- Attention to detail
- Ability to interpret and apply regulatory guidelines (CMS, HIPAA, state regulations)
- Effective verbal and written communication
- Ability to educate and collaborate with clinical and non-clinical staff
- Proficiency with EHR systems such as Epic
- Competency in Microsoft Office Suite (Excel, Word, Outlook)
Essential Functions
- Review and reconcile daily charge capture to ensure all services provided are accurately recorded and billed in accordance with payer and regulatory requirements.
- Analyze billing and coding practices for compliance with federal, state, and payer-specific guidelines, identifying and correcting discrepancies.
- Investigate and resolve claim denials by determining root causes, implementing corrective actions, and collaborating with relevant departments to prevent recurrence.
- Educate and provide guidance to clinical and non-clinical staff on documentation, coding standards, and billing procedures to support revenue integrity.
- Generate and analyze reports on revenue trends, charge capture effectiveness, and compliance issues to inform management and support decision-making.
- Monitor changes in billing, coding, and reimbursement regulations, updating internal processes and communicating updates to stakeholders as needed.
- Participate in audits and reviews of billing and coding practices to ensure ongoing compliance and identify opportunities for process improvement.
- Collaborate with clinical, financial, and IT teams to resolve charge capture, documentation, and billing issues impacting revenue.
- Maintain the confidentiality and security of patient information in accordance with HIPAA and organizational policies.
- Support the implementation of new systems, workflows, or regulatory requirements related to revenue integrity.
Preferred Qualifications
- Associate's or Bachelor's degree in Health Information Management, Business Administration, Healthcare Administration, Finance, or a related field.
- 3-5 years of experience in revenue integrity, charge capture, or healthcare compliance. Experience with Epic or similar electronic health record (EHR) systems.
- Active CPC, COC, RHIT, RHIA, or CCS certification at time of hire.
Overview
Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God’s love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.
