Job Description
Front-End Revenue Integrity Representative
Position Summary
This role is responsible for executing front-end and early revenue cycle billing functions in a fast-paced, high-volume urgent care environment. This role supports accurate eligibility verification, point-of-service (POS) collections, charge capture and posting, claims submission, and resolution of claim rejections. This role plays a critical role in ensuring clean claims, strong first-pass yield, and timely reimbursement.
Key Responsibilities
Eligibility Verification & POS Collections
Verify insurance eligibility and benefits for urgent care encounters using eligibility tools and payer portals.
Identify and correct eligibility and demographic errors prior to claim submission.
Ensure accurate collection and posting of POS payments, including copays, deductibles, self-pay deposits, and other patient financial responsibility in accordance with organizational policy.
Charge Capture & Charge Posting
Review urgent care encounters to ensure all billable services, procedures, vaccines, and supplies are accurately captured.
Post charges accurately and timely in the billing system based on provider documentation and coding guidance.
Identify missing or inconsistent charge information and coordinate resolution with clinic operations, coding, or providers as needed.
Claims Submission
Review and resolve any internal claim edit errors prior to clearinghouse claims submission.
Prepare and submit professional billing claims to payers and clearinghouses in accordance with payer-specific requirements.
Ensure claims meet clean-claim standards prior to submission.
Claim Rejection Resolution
Review and resolve claim rejections related to eligibility, demographics, coding, modifiers, or system edits.
Correct errors and resubmit rejected claims within established turnaround time standards.
Escalate recurring rejection trends or system issues to the Billing Supervisor.
Collaboration & Continuous Improvement
Collaborate with clinic operations, coding, and downstream revenue cycle teams to resolve issues impacting billing accuracy.
Identify workflow gaps or recurring errors and communicate improvement opportunities to leadership.
Required Qualifications
High school diploma or equivalent required; Associate degree preferred.
1–3 years of experience in professional (outpatient) medical billing, preferably in urgent care or high- volume ambulatory settings.
Working knowledge of insurance eligibility verification, POS collections, charge capture, and claims submission.
Basic understanding of CPT, ICD-10-CM, and modifier usage.
Experience using EHR/practice management systems and clearinghouses.
Familiarity with California payer requirements and regulatory considerations.
Preferred Qualifications
Experience supporting multi-site urgent care organizations.
Billing certification such as CPB or CPC (or progress toward certification).
Key Competencies
Strong attention to detail and accuracy
Ability to work efficiently in a high-volume environment
Problem-solving and root-cause identification skills
Clear written and verbal communication
Team-oriented, customer-service mindset
Working Conditions
Office or remote environment; flexibility for onsite work dictated by business needs