Revenue Integrity Senior Specialist

Job Purpose responsible for supporting revenue integrity initiatives through advanced analysis, auditing, 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. Roles and Responsibilities 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- Monitor revenue cycle activities to identify revenue leakage risks. - 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. - Revenue Leakage Analysis- Conduct revenue leakage assessments. - Analyze underpayments and missed charges. - Prepare recommendations to improve revenue capture. - Track implementation of corrective actions. Key Contacts Key Internal Stakeholders - Chief Commercial Officer - All staff Key External Stakeholders - Insurance Companies and TPAs - Council of Cooperative Health Insurance (CCHI) - NPHIES Platform Representatives - External Auditors and Coding Consultants - Regulatory Authorities (MOH) Requirements: Job Qualifications and Requirements Knowledge and Experience - 5-8 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 - Adaptability - Honesty and Integrity - Self-Motivated - Motivated to Grow and Learn - Strong Self-Confidence Competencies - Accountability - Attention to Detail - Continuous Improvement - Results Orientation - Professional Integrity - Revenue Integrity Analysis - Revenue Leakage Detection - Charge Capture Validation - Coding Compliance - Billing Integrity - Claims Analysis - Audit & Compliance - Healthcare Reimbursement