Revenue Integrity Specialist

WVU Medicine

. Reviews charge review, claim, and denial edits for compliance with CCI, OCE, MUE claim edits and LCD & NCD billing rules while maximizing reimbursement .

Posted 10/27/2026full-timeRemote • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in revenue cycle management, including compliance with CCI, OCE, MUE, LCD, and NCD billing rules. Proficient in analyzing billing trends and optimizing claim editing processes while ensuring effective communication with clinical leadership and compliance teams.

Highest-signal resume keywords

Revenue Cycle ExperienceICD-10, CPT & HCPCS KnowledgeAnalytical SkillsCommunication SkillsUnderstanding of Payor Policies

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Billing ComplianceClaim Editing SoftwareRoot-Cause AnalysisMicrosoft ExcelClaims ReviewCharge Capture OptimizationGovernment Regulations KnowledgePayer Appeal ProcessesData ReportingMedical Terminology

Soft Skills

Critical ThinkingClear CommunicationProfessional DemeanorInterpersonal SkillsOrganizational Skills

Tools & Technologies

Epic Revenue GuardianReporting ToolsCopierFax Machine

Industry Keywords

CCIOCEMUELCDNCDACP/MPFS Payment StructuresThird-Party Payment MethodologiesHealthcare ComplianceCharge Master CommitteeClinical Leadership

About the role

Key responsibilities & impact

Reviews charge review, claim, and denial edits for compliance with CCI, OCE, MUE claim edits and LCD & NCD billing rules while maximizing reimbursement
Supports development, testing, implementation, maintenance, and operational optimization of Epic’s Revenue Guardian module and related claim editing software
Monitors billing edit trends to identify retraining and editing-tool optimization needs
Communicates training and optimization needs to clinical leadership, chargemaster committee, compliance, and related areas
Manages payor and claim CCI, OCE, MUE, LCD and NCD edits accurately and compliantly
Tracks edited accounts, correspondence, actions, outcomes, coordination, and follow-up for payor and claim edits
Reports edit and denial appeal trends and activities to Revenue Cycle Leadership
Assists departments with compliance regarding government regulations related to claim edits
Works with revenue cycle leadership, chargemaster committee, and clinical departments to ensure optimal charge capture
Maintains current knowledge of payer policies and government regulations and communicates relevant information to leadership
Performs root-cause analysis for high-volume edits and works with Epic technical teams, clinical departments, and HIM to correct errors and missed charges
Reports claim-edit volumes and identifies new claim errors from updated policies
Performs claims reviews to ensure documentation supports captured charges
Supports Revenue Cycle Leadership and prioritizes work to reduce edit volume and meet payer appeal deadlines

Requirements

What you’ll need

High School Diploma or equivalent
Two (2) years of billing- revenue cycle experience
Must be capable of using computers effectively
Knowledge of medical terminology, ICD-10, CPT & HCPCS codes
Analytical, critical thinking and clear, concise communication skills are required to interact effectively with all levels of management
Must be capable of using copier/fax effectively
Good analytical skills including the use of Microsoft Excel and reporting tools
Good communication skills and professional demeanor required
Understanding of payor clinical reimbursement policies and government regulations
Understanding of ACP/MPFS payment structures and other third-party payment methodologies
Frequent walking, standing, stooping, kneeling, pushing, lifting, grasping, and feeling are necessary body movements utilized in performing duties through the work shift
Must be able to sit for extended periods of time
Must have reading and comprehension ability
Preferred: Bachelor’s degree in business or other healthcare related field or Health Information Technology graduate