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ABOUT THIS POSITIONThe Revenue Integrity Review Specialist is responsible for conducting high-quality medical record reviews on behalf of Customers. This role leverages advanced Coding and Clinical Documentation Integrity (CDI) expertise to identify documentation, coding, and reimbursement opportunities while ensuring compliance with industry standards and regulatory requirements.
The ideal candidate demonstrates exceptional attention to detail, strong critical thinking skills, and the ability to maintain a high level of accuracy, quality, and productivity in a production-based review environment. The Revenue Integrity Review Specialist consistently delivers efficient, clinically supported, and compliant review outcomes that align with customer expectations.WHAT YOU'LL DO
Conduct comprehensive medical record reviews toidentifyCoding, CDI,Qualityand revenue integrity opportunities.
Apply advanced knowledge of ICD-10-CM, ICD-10-PCS, MS-DRGmethodology, CDI principles, and clinical validation concepts to evaluate documentation accuracy, code assignment, and clinical support.
Identifydocumentationaccuracy opportunities and develop compliant physician queries when clarification is needed.
Ensure all review findings and recommendations areaccurate, clinically supported, compliant, and aligned with Official Coding Guidelines, AHIMA/ACDIS Query Practice Briefs, regulatory requirements, and customer-specific standards
Consistently achieve established productivity, quality, accuracy, and turnaround time standards while managing a high volume of reviews.
Prioritize workload effectively and work independently in a fast-paced production environment.
Maintain current knowledge of coding, CDI, reimbursement methodologies, clinical practice standards, and regulatory changes affecting review outcomes.
Deliver high-quality review results that meet customer expectations and organizational performance standards.
WHAT YOU'LL NEED
BSN, RHIA, RHIT, CCS, CCDS, CDIP, or equivalent healthcarecredentials.
3-5 years of experience ininpatientcoding, CDI, revenue integrity, auditing, orrelatedhealthcarefield.
Strong knowledge of ICD-10-CM/PCS coding guidelines, CDI practices, MS-DRG assignment, clinical validation, and physician query best practices.
Demonstrated ability to achieve productivity, quality, and accuracy standards in a high-volume review environment.
Strong analytical, critical thinking, and communication skills with the ability to work independently and manage competing priorities.
Dual certification (CCDS/CDIP and CCS) or willingness to obtainadditionalcertification.
Experience reviewing records within healthcare technology platforms, such as Prebill or similar clinical review solutions.
Through a smart platform and better experience, helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle.
’s healthcare payments platform combines innovative, cloud-based technology, robust data, and unparalleled client support to streamline workflows and improve financials so providers can focus on what matters most: their patients and communities. is trusted by 1M+ providers, 1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid/Medicare payers. We are deeply committed to living out our organizational values: honesty; kindness; passion; curiosity; fanatical focus; best work, always; making it happen; and joyful, optimistic & fun.
products have won multiple Best in KLAS® or Category Leader awards since 2010 and earned multiple #1 rankings from Black Book™ surveys since 2012. The platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and health plans. For more information, visit waystaror follow @on Twitter.
WAYSTAR PERKS
is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
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