Revenue Integrity Review Specialist

Key Responsibilities 

Medical Record Review and Analysis 

• Conduct comprehensive medical record reviews to identify Coding, CDI, Quality and revenue integrity opportunities. 

• Apply advanced knowledge of ICD-10-CM, ICD-10-PCS, MS-DRG methodology, CDI principles, and clinical validation concepts to evaluate documentation accuracy, code assignment, and clinical support. 

• Identify documentation accuracy opportunities and develop compliant physician queries when clarification is needed. 

• Ensure all review findings and recommendations are accurate, clinically supported, compliant, and aligned with Official Coding Guidelines, AHIMA/ACDIS Query Practice Briefs, regulatory requirements, and customer-specific standards 

Quality, Productivity, and Performance 

• Consistently achieve established productivity, quality, accuracy, and turnaround time standards while managing a high volume of reviews. 

• Prioritize workload effectively and work independently in a fast-paced production environment. 

• Maintain current knowledge of coding, CDI, reimbursement methodologies, clinical practice standards, and regulatory changes affecting review outcomes. 

• Deliver high-quality review results that meet customer expectations and organizational performance standards. 

Minimum Qualifications 

• BSN, RHIA, RHIT, CCS, CCDS, CDIP, or equivalent healthcare credentials. 

• 3-5 years of experience in inpatient coding, CDI, revenue integrity, auditing, or related healthcare field. 

• Strong knowledge of ICD-10-CM/PCS coding guidelines, CDI practices, MS-DRG assignment, clinical validation, and physician query best practices. 

• Demonstrated ability to achieve productivity, quality, and accuracy standards in a high-volume review environment. 

• Strong analytical, critical thinking, and communication skills with the ability to work independently and manage competing priorities. 

Preferred Qualifications 

• Dual certification (CCDS/CDIP and CCS) or willingness to obtain additional certification. 

• Experience reviewing records within healthcare technology platforms, such as Prebill or similar clinical review solutions. 

ABOUT WAYSTAR

Through a smart platform and better experience, Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle.

Waystar’s healthcare payments platform combines innovative, cloud-based technology, robust data, and unparalleled client support to streamline workflows and improve financials so providers can focus on what matters most: their patients and communities. Waystar is trusted by 1M+ providers, 1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid/Medicare payers.  We are deeply committed to living out our organizational values: honesty; kindness; passion; curiosity; fanatical focus; best work, always; making it happen; and joyful, optimistic & fun.

Waystar products have won multiple Best in KLAS® or Category Leader awards since 2010 and earned multiple #1 rankings from Black Book™ surveys since 2012. The Waystar platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and health plans. For more information, visit waystar.com or follow @Waystar on Twitter.