Houston Methodist · 1 week ago
Revenue Integrity Specialist
Houston, TX
Full-time
Onsite
Mid Level
3+ years expHouston Methodist is seeking a Revenue Integrity Specialist to ensure accurate patient registration and billing. The role involves data entry, auditing, maintaining charge descriptions, and identifying revenue opportunities.
Health CareMedical
Responsibilities
Ensures that the appropriate charges are assigned and entered into the system for accurate patient registration and/or billing
Accurately enters data and makes edits as required; performs data integrity checks and daily reconciliation of charges and accounts; assists in auditing and in correcting documentation issues; and generates, copies, and distributes reports as directed by management
Maintains a current and accurate Charge Description Master (CDM) in accordance with coding regulations and guidelines and updates procedure codes as required
Monitors for trends and identifying missed revenue opportunities and areas for potential revenue enhancement
Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal departmental and organizational results
Develops, fosters and maintains a network of all organizational stakeholders involved in charge entry and processing to assist in the efficient resolution of charge reconciliation issues
Responds to questions regarding charge capture, serves as a subject matter expert in the area of charge capture, and trains/mentors others in related charge capture roles
Performs data entry of clinical and/or operational information from worksheets and other data collection and reporting tools
Accurately enters all data into applicable databases ensuring timeliness and prevention of backlog
Identifies errors, performs problem solving, makes edits and updates records accordingly
Handles work queues daily, organizes workflow, problem-solves, and manages multiple ongoing priorities with minimal supervision
Generates, copies, and distributes reports as directed by management
Independently utilizes available resources to include electronic tools (e.g., electronic health records, spreadsheets, etc.) to gain understanding of process and edits in order to identify and resolve charge correction and/or registration issues
Works daily with external and/or internal areas such as payors (where appropriate), information technology, registration, health information management, and/or billing to address edit issues that require specialized analysis; triages issues to appropriate department(s) to promote resolution identified
Evaluates charges and validates accuracy
When inaccurate, makes revisions by adding, editing, and/or deleting inappropriate charges
Identifies and corrects charging errors involving transfer of charges to correct accounts as appropriate
Maintains strict confidentiality of patients, employees and hospital information at all times
Ensures protection of private health and personal information
Adheres to all Health Insurance Portability and Accountability Act (HIPAA) and Payment Card Industry (PCI) compliance regulations
Ensures charges are audited, entered, and confirmed within timeframe set forth by Houston Methodist in order to meet Accounts Receivable (AR) Days metrics
Enters charges as required while closely adhering to system documentation
Evaluates charges to ensure billing integrity and works with physicians and clinicians on documentation amendments as necessary to optimize reimbursement
Develops and implements charge reconciliation processes and tools for the clinical operations team to effectively use on the front end
Monitors for trends and identification of missed revenue opportunities and areas for potential revenue enhancement
Displays initiative to improve accuracy and timeliness of charge capture and documentation
Takes an active role in establishing consistency across respective stakeholders as changes in processes, tools, and overall practices are developed and implemented
Keeps abreast of market and payor trends as they relate to the department
Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development (i.e., participates in training opportunities, focal point review activity, etc.)
Applies new learning
Qualification
Required
Associate's degree or higher in billing, coding, accounting, or related field; or high school diploma with additional two years of related experience (in addition to the minimum experience requirements listed below) in lieu of college degree
Three years of experience in patient accounting, revenue cycle, coding, or other related area
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
Familiarity with general International Classification of Disease (ICD) and Current Procedural Terminology (CPT) coding
Knowledge of medical terminology
Understanding of accreditation and government regulations (e.g., CMS) as applicable to scope of department
Ability to be self-motivated and work independently with minimal supervision
Proficient computer skills in Microsoft Office components, including Excel, and ability to learn and navigate multiple software programs
Ability to think critically, analyze and solve problems
Strong organizational skills
Ability to handle detail work accurately and rapidly
Ability to follow-through and handle multiple tasks simultaneously
Company
Houston Methodist
Houston Methodist is one of the nation’s leading health systems and academic medical centers.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Brooke Graham
CEO Project Director
David P. Bernard
Chief Executive Officer & Senior Vice President
Recent News
2025-12-07
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