Revenue Cycle Integrity Specialist

Neurosurgery Revenue Integrity Specialist (Coding + Authorization + Charge Capture Oversight) Position Summary The Neurosurgery Revenue Integrity Specialist is responsible for ensuring accurate, timely, and complete charge capture by bridging coding, prior authorization, and clinical documentation workflows. This role proactively identifies and resolves gaps that lead to missed revenue, authorization denials, and delayed billing by working directly with physicians, coders, and authorization teams. Core Responsibilities 1. Coding & Charge Capture Oversight Review daily coding output for completeness and accuracy prior to claim submission Ensure all scheduled encounters are coded and billed (no missed charges) Validate

CPT/HCPCS

alignment with codes prior authorized. Identify discrepancies between MaxRVU / operative intent vs billed CPTs Partner with Coding Supervisor and Coding Vendor to correct errors in real time 2. Prior Authorization Validation Crosswalk scheduled procedures against authorized CPT codes Identify mismatches between: Scheduled procedure Authorized services Final billed services Collaborate with Prior Authorization team to: Update authorizations when procedures change Prevent "authorized for wrong CPT" denials Ensure high-dollar and high-risk cases are validated pre-DOS when possible 3. Physician Communication & Pend Resolution Manage and work the Coding Pend Report daily Communicate directly with physicians on: Missing operative details Incomplete documentation Required clarifications for coding specificity Follow up on: Missing operative notes Missing hospital documentation Provide clear, concise feedback to physicians on what is needed 4. Missing Encounters & Documentation Monitoring Run and reconcile Missing Encounter Reports daily Track and resolve: Uncoded visits Unbilled surgeries Hospital encounters without documentation Monitor for: Operative notes not completed Hospital consults/procedures not captured Escalate trends impacting charge lag or Days in A/R to the Supervisor/Director 5. Denial Prevention & Resolution Work authorization- and coding-related denials Identify root causes: Authorization mismatch Incorrect CPT selection Documentation deficiencies Partner with A/R team to: Provide guidance on how to Correct and resubmit claims Support appeals with clinical/coding validation Appeal writing Feed denial trends back to Coding and Auth teams for process improvement 6. Cross-Functional Coordination Act as liaison between: Neurosurgery physicians Coding team (AiHealth + internal workflows) Prior Authorization team A/R follow-up team Participate in workflow improvement initiatives across: Surgimate Veradigm PM Clinical documentation flow (Concord/EHR) Key Performance Indicators (KPIs) This is where the role becomes powerful: Coding Turnaround Time (TAT) Authorization-Related Denial Rate (↓ target) Charge Lag (DOS to Posted) % of Cases with Auth-to-CPT Match AR > 90 Days (Neurosurgery-specific improvement) Operative Note Completion Timeliness Required Skillset Strong knowledge of: Neurosurgery CPT coding & surgical workflows Prior authorization processes (commercial + Medicare Advantage) Denial management and appeals Experience with:

EHR + PM

systems (Veradigm/Allscripts preferred) Surgical workflows (Surgimate experience a plus) Ability to: Communicate effectively with physicians (concise, clinical-aware) Analyze reports and identify revenue leakage patterns Work across departments without silos Ideal Background Certified Coder (CPC, CCS, or equivalent) 3-5+ years in surgical coding, revenue cycle, or denial management Experience in neurosurgery or high-acuity surgical specialties strongly preferred

Pay:

$27.00 - $30.00 per hour

Benefits:

401(k) AD&D insurance Dental insurance Employee assistance program Flexible spending account Health insurance Health savings account Life insurance Paid time off Referral program Tuition reimbursement Vision insurance

Experience:

Surgical Coding:

3 years (Preferred)

Neurosurgery:

1 year (Preferred)

License/Certification:

Certified Professional Coder (Required)

Work Location:

In person