Revenue Integrity Supervisor - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

Scheduled Weekly Hours:

Position Overview

Leads daily operations of Revenue Integrity work queues and staff, ensuring accurate, compliant, and timely pre-bill claim readiness across hospital and ambulatory services. Responsible for frontline execution, quality control, escalation management, and team coaching across charge integrity, authorization integrity, surgical implant/device reconciliation, and CDM support workflows. Ensures high-risk accounts are identified and corrected prior to billing, with specific operational oversight of pre-bill charge verification, authorization validation pre-service and post-procedure pre-bill to ensure the authorization aligns with procedures actually performed. Partners closely with clinical departments, central scheduling, pharmacy, patient financial services, and informatics to resolve upstream defects and prevent revenue leakage.

MINIMUM REQUIREMENTS

Education: Associate degree in Nursing, Health Information, Healthcare Administration, Business, or related field required. High School diploma or equivalent and additional years of experience may be considered in lieu of a formal associate's degree.

Experience: Four years' progressively responsible experience in hospital revenue cycle, revenue integrity, patient financial services, or related function required. One year' lead/supervisory experience preferred. Demonstrated experience with pre-bill charge review, authorization workflows, and account-level correction processes required. Experience with procedural areas (OR, Cath Lab, IR, imaging, cardiology, etc.) preferred.

Other Credentials:

Knowledge and Skills: Strong knowledge of hospital charge capture, CPT/HCPCS/revenue code usage, and claim workflow dependencies. Strong understanding of payer authorization requirements and procedure/auth alignment risks. Strong analytical, organizational, and follow-through skills with the ability to manage high-volume, time-sensitive work queues. Strong communication and conflict-resolution skills across clinical, operational, and physician office stakeholders. Ability to coach staff, enforce standards, and drive accountability.

Special Training: Proficiency in EHR and revenue cycle systems, work queues, and account review tools. Strong Excel and reporting/dashboard proficiency. Ability to document trends, root causes, and corrective action plans.

Mental, Behavioral and Emotional Abilities: Ability to function with minimal supervision and exercise sound judgment. Ability to collect, create and research complex or diverse information

Usual Work Day: 8 Hours

Reporting Relationships

Does this position formally supervise employees? Yes

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

ESSENTIAL FUNCTIONS

Supervises day-to-day Revenue Integrity operations and staff performance across assigned work queues. Assigns, prioritizes, and monitors work based on risk, filing timeliness, and financial exposure.

Oversees pre-bill charge integrity review, including missing/incorrect CPT, HCPCS, revenue code, and unit corrections.

Oversees authorization integrity workflows including: pre-service verification that required authorizations are present and accurate, and post-procedure pre-bill validation that approved authorization(s) match procedures actually performed (CPTs, units, setting, dates, site of service).

Oversees surgical/procedural revenue integrity controls, including implant/drug/device reconciliation, invoice availability checks, and hold/release management for unresolved high-risk accounts.

Coordinates daily escalation management with Central Scheduling, procedural departments, physician offices, pharmacy, and billing to resolve issues before claim finalization.

Enforces standard documentation requirements for account notes, issue categorization, action tracking, and closure rationale.

Performs quality audits of teamwork, provides feedback, and drives corrective action for performance and process variation.

Participates in review of operational KPIs (volume, aging, correction turnaround time, preventable risk, escalation outcomes, repeat root causes) and makes adjustments to workload prioritization as needed.

Partners with CDM resources to route and prioritize recurring build/maintenance defects identified through account-level review.

Supports implementation of policy changes, payer rule updates, and workflow redesign under direction of the Manager, Revenue Integrity.

Maintains cross-functional working relationships and participates in recurring operational huddles and governance meetings.

Coaches team members, supports onboarding/training, and builds bench strength for role continuity and succession.

Performs other duties as assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

Frequent physical demands include:

Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl

Continuous physical demands include: Sitting , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion , Talk or Hear

Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include:

Anticipated Occupational Exposure Risks Include the following: N/A
 

IND123.

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.