Revenue Integrity Specialist

Description

Job Propose

responsible for supporting revenue integrity initiatives through advanced analysis, monitoring, and optimization of revenue cycle processes. The role focuses on identifying revenue leakage opportunities, validating charge capture accuracy, ensuring coding and billing compliance, and supporting reimbursement optimization efforts.

The position works closely with clinical, coding, billing, contracting, and finance teams to ensure revenue integrity controls are effectively implemented and maintained in accordance with Saudi healthcare regulations, CCHI requirements, and NPHIES standards.

Organizational Accountabilities:

• Ensure work is performed based on approved policies, processes, procedures, and instructions
• Identify opportunities for continuous improvement of systems, processes and practices considering leading practices, cost reduction and productivity improvement
• Ensure day-to-day activities are properly performed in line with policies and procedures

Follow-up on escalated cases/issues of subordinates to ensure they are closed efficiently and in a timely manner

Functional Accountabilities:

• Revenue Integrity Monitoring
• Review charge capture processes and identify missed revenue opportunities.
• Validate charging accuracy across clinical departments.
• Support implementation of revenue integrity controls.
• Coding & Documentation Review
• Review coding accuracy and reimbursement impact.
• Analyze documentation deficiencies affecting claims and reimbursement.
• Support coding compliance initiatives.
• Coordinate with Coding and CDI teams to improve documentation quality.
• Claims & Billing Validation
• Review claims for accuracy before submission.
• Identify billing discrepancies and reimbursement risks.
• Investigate claim rejections and denial trends.

Support corrective action implementation

Key Internal Stakeholders:

• Chief Commercial Officer

All staff

Key Exernal Stakeholders:

• Insurance Companies and TPAs
• Council of Cooperative Health Insurance (CCHI)
• NPHIES Platform Representatives
• External Auditors and Coding Consultants

Regulatory Authorities (MOH)

Requirements

Knowledge and Experience

3-5 years of experience in revenue cycle management, revenue integrity, coding, or healthcare finance, with at least 5 years in a senior leadership role.

Strong knowledge of Saudi healthcare reimbursement frameworks, including CCHI and NPHIES.

In-depth understanding of clinical documentation, coding standards, and billing regulations.

Proven experience leading revenue integrity programs and audit initiatives.

Strong analytical, leadership, and stakeholder management skills.

Experience working with HIS, billing, and analytics systems.

Education and Certifications

• Bachelor’s degree in Healthcare Administration, Health Information Management, Finance, or related field (required).
• Certified Revenue Cycle Professional (CRCP) or equivalent – highly desirable.
• Certified Coding Specialist (CCS) or CPC – advantageous.
• Certified Healthcare Financial Professional (CHFP) – preferred.
• Training or certification related to CCHI / NPHIES – highly desirable.

Continuous professional development in healthcare revenue integrity and compliance is required.

Skills :

Proven expertise in healthcare and government sectors, with strategic planning capabilities.

Strong skills in communication, mediation, and conflict resolution.

Deep understanding of data compliance, regulations, and policies.

Excellent administrative and organizational skills.

Good communication skills in Arabic and English (verbal and written).

Strong proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook).

Ability to prepare clear reports, meeting minutes, and maintain accurate records.

Attitude :

Strong Work Ethic

Dependability and Responsibility

Possessing a Positive Attitude

Summary