Revenue Integrity Review Specialist

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.

The ideal candidate demonstrates exceptional attention to detail, strong critical thinking skills, and the ability to maintain a high level of accuracy, quality, and productivity in a production-based review environment. The Revenue Integrity Review Specialist consistently delivers efficient, clinically supported, and compliant review outcomes that align with customer expectations.

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 i npatient c oding, 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.

Waystar Perks

• Competitive total rewards (base salary + bonus, if applicable)
• Customizable benefits package (3 medical plans with Health Saving Account company match)
• We offer generous paid time off for our non-exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays. We also offer flexible time off for our exempt team members + 13 paid holidays
• Paid parental leave (including maternity + paternity leave)
• Education assistance opportunities and free LinkedIn Learning access
• Free mental health and family planning programs, including adoption assistance and fertility support
• 401(K) program with company match
• Pet insurance
• Employee resource groups

This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.