FT-Revenue Integrity & Denials Specialist II - Patient Accounting

At Ashe Memorial Hospital, we are driven by our mission:
“To meet the needs of the community by delivering patient-centered, high quality health care.”

Ashe Memorial Hospital is proud to have been voted Ashe’s Best Place to Work in 2022, 2023, 2024, and 2025. Join a team recognized throughout the community for excellence in healthcare, including awards for Best Hospital, Best Surgeon, Best Physician, Best Nurse, and Best Medical Practice. This is your opportunity to make a meaningful difference in a close-knit mountain community.

Hours: 1st shift | No Supervisory Responsibilities | No Travel | Pay commensurate with experience

Full-time, day shift position in Patient Accounting.

JOB SUMMARY:

The Revenue Integrity/Denials Specialist II is responsible for supporting the organization’s revenue cycle through comprehensive oversight of revenue integrity processes, denial prevention and resolution, and Charge Description Master (CDM) maintenance and optimization. This position serves as a key resource in identifying revenue leakage, ensuring compliance with regulatory and payer requirements, improving charge capture accuracy, and collaborating with operational departments to strengthen reimbursement outcomes.

The role functions as a liaison among Revenue Cycle, Coding, Clinical Departments, Pharmacy, Laboratory, Materials Management, and Finance to ensure accurate billing practices, compliant charging workflows, and effective denial mitigation strategies.

Minimum Job Qualifications:

• Education Bachelor’s degree preferred.

• Associate degree in Healthcare Administration, Business, Finance, Health Information Management, or related field required.

Certifications Preferred:

• Certified Revenue Cycle Representative (CRCR)
• Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)
• HFMA Revenue Cycle Certification
• Revenue Integrity Certification preferred

Employees hired without a certification may be required to obtain an approved certification within 12 months of hire

Essential Duties and Responsibilities

Revenue Integrity Oversight

• Monitor and analyze charge capture processes to identify missed revenue opportunities, billing inaccuracies, and compliance concerns.
• Conduct routine audits of CDM structures, charge processes, and reimbursement methodologies.
• Review and validate charging workflows to ensure accurate and compliant revenue capture.
• Identify trends contributing to revenue leakage and recommend corrective actions.
• Support initiatives that improve reimbursement accuracy and reduce operational inefficiencies.

Denials Management

• Review, investigate, and resolve denied or underpaid claims.
• Analyze denial trends to identify root causes and implement process improvement strategies.
• Collaborate with Coding, Billing, Clinical Departments, and Payers to resolve claim issues timely and effectively.
• Monitor payer regulations and communicate changes impacting reimbursement or denial prevention.
• Assist with appeal preparation and supporting documentation as necessary.

Charge Description Master (CDM) Management

• Assist with maintenance and integrity of the hospital CDM.
• Review CDM entries for compliance with CPT, HCPCS, ICD-10, revenue codes, modifiers, and payer requirements.
• Coordinate annual and ongoing coding updates within the CDM.
• Collaborate with department leaders to ensure new services, supplies, medications, and procedures are appropriately built and billed.
• Validate pricing structures, revenue code assignments, and charge mappings.

Interdepartmental Collaboration

• Participate in and facilitate semiannual CDM review meetings with designated departments, including:
  • Materials Management
  • Laboratory
  • Pharmacy
  • Coding
  • Same Day Care (SDC)
  • Rehabilitation
  • Emergency Department (ER)
  • Inpatient (IP)
  • Outpatient (OP)
• Serve as a revenue integrity resource for departments regarding charging practices and documentation requirements.
• Educate staff on charging accuracy, denial prevention, and revenue cycle best practices.

Compliance & Reporting

• Maintain compliance with all federal, state, payer, and organizational billing regulations.
• Prepare reports related to denials, revenue integrity findings, and CDM audit results.
• Track and report identified trends, corrective actions, and financial impacts.
• Assist leadership with revenue cycle performance improvement initiatives.

Candidate Expectations

We are seeking a motivated and team-oriented professional who demonstrates collaboration, accountability, and positive representation of Ashe Memorial Hospital. The ideal candidate values professionalism, communication, and exceptional service while supporting the hospital’s mission of delivering outstanding patient-centered care.

Additional Requirements

• Must be willing to receive all required vaccinations as a condition of employment unless an approved exemption has been granted
• Criminal background check and pre-employment drug screening required upon conditional offer of employment

Application Instructions

To apply, please complete an employment application and attach:

• Resume
• Cover Letter
• Employment history including explanations for gaps in employment and reasons for separation

Benefits

Benefits become effective the first of the month following employment, in accordance with hospital policy.

For a full job description and complete benefits information, please contact Human Resources.

Equal Opportunity Employer

Ashe Memorial Hospital is an Equal Opportunity Employer and considers applicants based on qualifications, experience, and ability to perform the essential functions of the position. Reasonable accommodations may be made for qualified individuals with disabilities without compromising patient care. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, genetic information, or any other status protected by applicable law.