Revenue Integrity Specialist at CareWell Health – East Orange, New Jersey

Job Summary

The Revenue Integrity Specialist is responsible for the seamless integration of the patient experience, from initial contact to final payment. This role requires a high level of accuracy in scheduling clinical appointments, obtaining complex prior authorizations, and managing the billing lifecycle to ensure maximum reimbursement and patient satisfaction across the Family Health Center.

Essential Functions

• Coordinate and schedule patient appointments and diagnostic tests using the EHR/PMS system.
• Optimize the provider’s calendar by balancing urgent fits with routine follow-ups.
• Manage "no-show" protocols and waitlists to maintain high clinic utilization.
• Verify insurance eligibility and benefits coverage prior to the date of service.
• Submit and track prior authorization requests for procedures, medications, or specialist referrals.
• Liaise with insurance clinical reviewers to provide necessary medical records or "Letter of Medical Necessity" documentation.
• Manage Denials: Investigate rejected claims, file appeals, and correct billing errors.
• Calculate and collect patient co-pays, deductibles, and outstanding balances at the time of service.

Other Duties

Please note that this job description is not designed to cover or list all activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Minimum Education/Certifications

High School Diploma Required. Comprehensive Knowledge of the State regulations for Patient Accounts billing. Certification as a Revenue Integrity Professional (CRIP) preferred.

Knowledge of Patient Account terminology and able to understand Explanation of Benefits. Good communication and customer service skills are a must.

Minimum Work Experience

• 2+ years in medical front-office, billing, or authorization roles.

• Proficiency in EHR systems (e.g., Epic, Athena, eClinicalWorks) and clearinghouses.
• Strong grasp of medical terminology, PPO/HMO/Medicare/Medicaid structures.
• Ability to explain complex financial responsibilities to patients with empathy.
• Persistence in following up with insurance companies regarding "pending" authorizations.

Position Type/Expected Hours of Work: Full-time (37.5 hours a week)

Working Conditions:

A typical office setting requires sitting, writing, and using office equipment such as computers, calculators, telephones, fax machines, and copiers. Limited lifting is required. Requires attention to detail and full concentration to assure accuracy.