Revenue Integrity Coordinator

Job Summary: Under the supervision of the Revenue Integrity Supervisor (RIS), the Revenue Integrity Coordinator (RIC) of Omni Family Health (Omni) provides revenue integrity support to a growing network of state-of-the-art health centers serving California’s Central Valley. As a member of the organization’s Fiscal Department, the RIC is responsible for ensuring accurate and compliant charge capture, documentation, coding, and billing of clinical services across the organization. This role safeguards organizational revenue by identifying discrepancies, preventing revenue leakage, and promoting compliance with regulatory and payer requirements. Focused on prospective review and continuous process improvement, the Coordinator works to identifying systematic issues before they impact claims, optimizing charging workflows, and ensuring that clinical services are documented and billed correctly the first time. Job Duties: Monitors charge capture to ensure that services provided by clinical staff are accurately documented and submitted for billing in accordance with organizational and payer requirements. Reviews daily charges for completeness and accuracy, identifying missing, duplicate, or incorrect charges and coordinating corrections with departments. Identifies inconsistencies between documentation and billed services, determines areas of revenue leakage, and recommends process improvements to leadership. Collaborates with the coding team to ensure accurate application of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Internal Classification of Diseases, Tenth Revision (ICD-10) codes and alignment with documentation. Partners with Managed Care and Revenue Cycle Management (RCM) teams to reduce denials and outstanding claims; analyzes trends in payer denials related to coding or documentation and communicates patters to prevent repeated errors. Supports RCM in reviewing Accounts Receivable (A/R), conducting monthly reconciliation, monitoring key performance indicators (KPIs), and presenting findings to leadership and clinical teams. Reviews vendor billing workflows for medication services across medical, pharmacy, and retail pharmacy environments, including Uniform Data System (UDS), Federally Qualified Health Center (FQHC) Prospective Payment System (PPS), Managed Care, and Medicare/Medicaid billing models. Support contract pharmacy performance reviews, operational oversight, and revenue optimization. Monitors payer policy updates related to drug reimbursement, prior authorization requirements, and formulary coverage. Reviews pharmacy, medical, and dental utilization, reimbursement data, and KPIs—including 340B Drug Pricing Program savings, denial trends, and revenue leakage —to support improvement efforts. Ensures billing practices follow federal, state, and program-specific regulations, including the Centers for Medicare and Medicaid Services (CMS), Medicare, Medi-Cal, and payer guidelines. Maintains compliance with local, state, and federal regulations related to revenue integrity and billing. Support internal audits, self-audits, and Health Resources and Services Administration (HRSA) audit readiness by maintaining documentation, identifying compliance risks, and assisting with corrective action plans. Educates departments on proper documentation practices to support compliant billing and accurate charge capture. Partners with Finance and clinical departments to streamline charging workflows and improve operational efficiency. Support leadership with reporting for internal stakeholders and Board-level updates related to program performance, revenue integrity, and compliance efforts. Pulls and analyzes revenue integrity reports, including charge lag, late charges, denial trends, and other performance indicators, to identify patterns and drive improvement. Ensures the department provides cohesive support to the mission, vision, and core values while delivering superior customer service. Works closely with all corporate branches, divisions, and/or departments in accordance with Omni’s policies and procedures. Other duties and/or responsibilities as the RIC may be assigned from time to time. Some travel may be required. Additional Duties: Health Insurance Portability and Accountability Act (HIPAA) Compliance: Responsible for maintaining abreast of and in compliance with all HIPAA regulations and requirements. Compliance: Ensures compliance with all local, state, and federal regulations. Quality Assurance/Quality Improvement (QA/QI): Participates as required in QA/QI activities and contributes towards the overall quality improvement initiatives of the organization. Information Technology (IT): May be required to learn and use the electronic health record and its components as required by the job functions and highlighted in the policies and procedures. These components include NextGen, Practice Management System (PMS), Quality Systems Inc. (QSI), and other electronic features as they are developed and implemented, as applicable to work environment. Patient Centered Medical Home (PCMH): All employees will participate in PCMH at Omni Family Health. Audits: Contributes to required Health Resources and Services Administration (HRSA), Operational Site Visit (OSV), The Joint Commission (JC), and other audit events. Qualifications, Education, and Experience: High School Diploma or GED certificate. Associate’s Degree in Pharmacy, Health Information Technology, Business, Healthcare Administration, or related field preferred. 340B Apexus Advance Certification (ACE) preferred. Two (2) years of experience in revenue cycle management, medical billing, or related field, preferably within a Federally Qualified Health Center (FQHC), multi-clinic healthcare, or nonprofit setting. Demonstrated experience in supporting charge reconciliation, documentation review, or revenue integrity functions. Familiarity with split-billing software, reporting tools, and electronic health record (her) systems (e.g. NextGen). Working knowledge of 340B regulatory guidance, billing practices, and HRSA audit preparedness. Foundational knowledge of drug pricing, reimbursement methodologies, and coding principals. Proficient in Microsoft Office Suite (Word, Outlook, Excel). Skills/Competencies: Strong analytical and problem-solving skills, with the ability to interpret complex billing and utilization data. Exceptional attention to detail, with a strong commitment to data integrity, accuracy, and regulatory compliance. Ability to work independently, prioritize multiple tasks, and manage competing deadlines in a fast-paced environment. Demonstrated professionalism and discretion in handling sensitive, confidential, and protected health information. Collaborative and team-oriented mindset, with strong customer-service skills and the ability to work effectively across clinical, administrative, and revenue cycle teams. Service Commitments: Must be alert and respect confidentiality of information of all types “general personnel, and/or patient related information.” Promotes and believes in Omni’s mission statement. Ability to relate to the public regardless of race, ethnicity, religion, age, sex, disability, or economic status. Responsible To: Revenue Integrity Supervisor Classification: Nonexempt