Front End Revenue Integrity Representative

Front-End Revenue Integrity Representative

Position Summary

This role is responsible for executing front-end and early revenue cycle billing functions in a fast-paced, high-volume urgent care environment. This role supports accurate eligibility verification, point-of-service (POS) collections, charge capture and posting, claims submission, and resolution of claim rejections. This role plays a critical role in ensuring clean claims, strong first-pass yield, and timely reimbursement.

Key Responsibilities

Eligibility Verification & POS Collections

    Verify insurance eligibility and benefits for urgent care encounters using eligibility tools and payer portals.

    Identify and correct eligibility and demographic errors prior to claim submission.

    Ensure accurate collection and posting of POS payments, including copays, deductibles, self-pay deposits, and other patient financial responsibility in accordance with organizational policy.

Charge Capture & Charge Posting

    Review urgent care encounters to ensure all billable services, procedures, vaccines, and supplies are accurately captured.

    Post charges accurately and timely in the billing system based on provider documentation and coding guidance.

    Identify missing or inconsistent charge information and coordinate resolution with clinic operations, coding, or providers as needed.

Claims Submission

    Review and resolve any internal claim edit errors prior to clearinghouse claims submission.

    Prepare and submit professional billing claims to payers and clearinghouses in accordance with payer-specific requirements.

    Ensure claims meet clean-claim standards prior to submission.

Claim Rejection Resolution

    Review and resolve claim rejections related to eligibility, demographics, coding, modifiers, or system edits.

    Correct errors and resubmit rejected claims within established turnaround time standards.

    Escalate recurring rejection trends or system issues to the Billing Supervisor.

Collaboration & Continuous Improvement

    Collaborate with clinic operations, coding, and downstream revenue cycle teams to resolve issues impacting billing accuracy.

    Identify workflow gaps or recurring errors and communicate improvement opportunities to leadership.

Required Qualifications

    High school diploma or equivalent required; Associate degree preferred.

    1–3 years of experience in professional (outpatient) medical billing, preferably in urgent care or high- volume ambulatory settings.

    Working knowledge of insurance eligibility verification, POS collections, charge capture, and claims submission.

    Basic understanding of CPT, ICD-10-CM, and modifier usage.

    Experience using EHR/practice management systems and clearinghouses.

    Familiarity with California payer requirements and regulatory considerations.

Preferred Qualifications

    Experience supporting multi-site urgent care organizations.

    Billing certification such as CPB or CPC (or progress toward certification).

Key Competencies

    Strong attention to detail and accuracy

    Ability to work efficiently in a high-volume environment

    Problem-solving and root-cause identification skills

    Clear written and verbal communication

    Team-oriented, customer-service mindset

Working Conditions

    Office or remote environment; flexibility for onsite work dictated by business needs