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The Revenue Integrity Review Specialist conducts high-quality medical record reviews to identify coding, CDI, and revenue integrity opportunities. They ensure all findings are compliant with regulatory standards and provide clinically supported documentation to meet customer expectations.
ABOUT THIS POSITION
The Revenue Integrity Review Specialist is responsible for conducting high-quality medical record reviews on behalf of Waystar Customers. This role leverages advanced Coding and Clinical Documentation Integrity (CDI) expertise to identify documentation, coding, and reimbursement opportunities while ensuring compliance with industry standards and regulatory requirements.WHAT YOU'LL DO
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.
WHAT YOU'LL NEED
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.
WAYSTAR PERKS
Waystar is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
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