Surgical Revenue Integrity Specialist Revenue Integrity & Denials Mgmt Lawrenceville NJ

Pay Range

$44.37 - $57.97

40 hours per week

Responsible for pre-bill revenue protection for surgical and procedural encounters, with primary focus on implant, device, and high-cost supply/drug-supported cases.

Performs detailed reconciliation of clinical and financial records to ensure complete and accurate charge capture before claim finalization.

Reviews physician operative/procedural reports, implant/device logs, purchasing documentation, and billing detail to identify missing invoices, missing charges, documentation‑to‑charge mismatches, and related claim‑readiness risks.

Supports trailer billing workflows by obtaining and validating implant/device invoice support and routing corrections to the appropriate operational teams.

This role is part of Revenue Integrity and collaborates with OR/Cath/IR departments, Purchasing/Supply Chain, Pharmacy, Patient Financial Services, and HIM/Coding as needed.

• Education:
  
  High school diploma or equivalent required. Associate degree in healthcare, nursing, health information, business, or related field preferred.
• Experience:
  
  Three years' hospital revenue cycle, charge capture, surgical billing support, OR/Cath/IR account review, or related experience required. Experience reconciling operative documentation, implant/device records, and pre‑bill accounts required. Experience with surgical/procedural case workflows (OR, Cath Lab, IR, Endo, etc.) strongly preferred.
• Registered Nurse (RN) license preferred, not required.
• Non‑RN candidates must demonstrate strong competency in interpreting operative/procedural documentation for charge integrity purposes.

Knowledge and

Skills:

Strong understanding of hospital charge capture and pre‑bill controls for surgical/procedural services. Working knowledge of CPT/HCPCS, modifiers, revenue codes, and unit-based charging concepts. Ability to interpret physician operative/procedural reports and correlate to billable services and implant/device usage. Strong analytical, organizational, and follow‑up skills in high-volume, time‑sensitive workflows. Effective communication skills with clinical and non‑clinical teams.

Special Training:
Proficiency with EHR/revenue cycle systems, account work queues, and case tracking tools. Proficiency in Excel and standard reporting tools.

Mental, Behavioral and Emotional Abilities:
Usual Work Day: 8 Hours.

Does this position formally supervise employees? No.

• Performs pre‑bill surgical revenue integrity review for designated accounts, prioritizing implant/device/high‑dollar procedural encounters.
• Reviews and interprets physician operative/procedural reports to validate that services performed are accurately reflected in pre‑bill charging records.
• Reconciles implant/device/supply usage across operative documentation, implant logs, supply chain/purchasing records, and account-level charge detail.
• Supports trailer billing workflows by obtaining, validating, and routing implant/device invoice support to appropriate teams for compliant claim submission.
• Identifies and documents defects including missing implant invoice, implant not billed, missing OR/procedural charges, under‑coded units, and documentation-to-charge mismatch.
• Coordinates with OR/Cath/IR leadership, Purchasing/Supply Chain, Pharmacy, and billing teams to resolve identified issues before claim release.
• Applies hold/release standards for unresolved high‑risk surgical accounts and escalates per policy to protect filing timeliness and revenue.
• Initiates and tracks correction requests through established correction pathways and ensures closure of issues.
• Documents account findings, issue category, root cause, action taken, and final…