Revenue Integrity Specialist

Care New England Health System (CNE)and its member institutions Butler Hospital Women & Infants Hospital Kent Hospital VNA of Care New England Integra The Providence Center and Care New England Medical Group is a trusted integrated health care organization that fuels the latest advances in medical research attracts the nations top specialty-trained doctors hones renowned services and innovative programs and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.

The Revenue Integrity Charge Capture specialist is responsible for ensuring the complete accurate and timely capture of hospital and professional charges across Care New England. This role focuses on proactive review and resolution of missing or incorrect charges through daily monitoring of Epic Revenue Guardian reports and charge-related work queues reconciliation of charges against clinical documentation and collaboration with operational clinical and coding teams to ensure compliance with federal state and third-party payor guidelines.

The Analyst supports charge integrity by verifying that all services provided are appropriately documented and coded using ICD-10-CM CPT and HCPCS classification systems. They perform reconciliation activities to identify gaps or discrepancies in revenue capture work to correct systemic or documentation-related issues and escalate concerns as needed.

In addition the Analyst assists with data extraction and reporting trend identification and audit preparedness. This role is a vital member of the Revenue Integrity team and serves as a resource to coding billing and operational staff regarding charge accuracy workflow compliance and revenue optimization strategies. The Analyst plays a critical role in maintaining data integrity reducing revenue leakage and supporting a compliant billing environment across the organization.

• High School or GED Required; Associates Degree Preferred
• Minimum 3 to 5 Years
• Strong working knowledge of CPT HCPCS and ICD-10 coding systems and their application to charge capture and reimbursement.
• Comprehensive understanding of healthcare revenue cycle operations particularly front-end processes and professional/facility charge capture.
• Familiarity with Medicare Medicaid and commercial payer billing and reimbursement guidelines.
• In-depth knowledge of Epic (or comparable EHR/EMR systems) including work queues and Revenue Guardian reporting tools.
• Understanding of compliance regulations including HIPAA and CMS guidelines related to billing practices.
• Awareness of Charge Description Master (CDM) structure and its impact on charging and reimbursement.
• High level of attention to detail with the ability to review clinical documentation for accurate translation into billable services.
• Strong analytical skills to identify trends discrepancies and root causes of charge capture issues.
• Effective written and verbal communication skills with the ability to explain complex charge or documentation issues clearly.
• Proficiency in Microsoft Excel and other reporting tools to extract analyze and present data.
• Time management and organizational skills to manage multiple tasks and meet daily/weekly deadlines.
• Ability to build productive relationships and collaborate across departments (clinical billing IT compliance).
• Ability to work independently while using sound judgment to escalate concerns when appropriate.
• Ability to interpret and apply regulatory changes and payer guidelines to operational workflows.
• Ability to navigate Epic and other systems to resolve charge capture issues efficiently.
• Ability to assess workflow inefficiencies and recommend process improvements.
• Ability to manage competing priorities and shift focus quickly in a dynamic environment.
• Commitment to maintaining confidentiality and upholding the highest standards of integrity and professionalism.

Americans with Disability Act Statement: External and internal applicants as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race color religion sex sexual orientation gender identity national origin veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including but not limited to hospital policy mission vision and values.