Revenue Integrity Specialist

Job Summary Responsible for supporting complete, accurate, and compliant charge capture across Care New England by analyzing clinical, financial, and operational data to identify trends, risks, and opportunities for improvement. This role goes beyond daily reconciliation to focus on proactive analysis, root cause identification, and development of sustainable process improvements to optimize revenue capture and reduce leakage. The Analyst leverages Epic Revenue Guardian reports, charge-related work queues, and other data sources to conduct in-depth reviews of charge capture activity, reconcile documentation against charges, and evaluate systemic issues impacting revenue integrity. In addition, the Analyst prepares and presents reports, dashboards, and trend analyses to leadership, supporting operational decision-making and audit readiness. This position serves as a subject matter expert and resource to coding, billing, clinical, and operational teams by providing insights on charge integrity. The Revenue Integrity Analyst plays a key role in strengthening the organization’s revenue cycle performance and ensuring an efficient billing environment. Duties and Responsibilities Conduct in-depth analysis of Epic Revenue Guardian reports, charge work queues, and other data sources to identify systemic charge capture issues, trends, and patterns. Reconcile clinical documentation against charges, with emphasis on identifying root causes of discrepancies and developing process improvements. Partner with Revenue Integrity leadership to monitor key performance indicators (KPIs), prepare dashboards, and present findings to management and clinical leaders. Collaborate with all revenue cycle teams to recommend workflow changes that improve documentation accuracy, charge capture, and reimbursement. Contribute to ongoing review and optimization of CDM and charge workflows, ensuring alignment with regulatory and payer guidelines. Assist in the development of Revenue Guardian rules, edits, and reports to improve monitoring and charge capture. Prepare detailed audit support documentation and partner with revenue cycle leaders on internal and external audit responses. Identify and upscale systemic revenue leakage issues, recommending strategies for resolution. Support development of training materials and provide guidance to clinical and operational teams on charge capture best practices. Stay current on regulatory changes, payer policies, and industry best practices, and assess their impact on charge capture workflows. Serve as a subject matter expert for charge integrity initiatives, providing insights and recommendations to leadership. Demonstrate accountability and initiative in advancing organizational goals around revenue optimization, and efficiency. Requirements High School or GED Required; Associate's Degree Preferred. Minimum 3 to 5 Years Experience Knowledge of CPT, HCPCS, and ICD‑10 coding systems and their application to charge capture and reimbursement. Strong understanding of healthcare revenue cycle operations, including facility and professional billing workflows. Familiarity with Medicare, Medicaid, and commercial payer reimbursement methodologies and requirements. Proficiency with Epic (or comparable EHR/EMR systems), with the ability to analyze work queue data, configure Revenue Guardian rules, and develop reports. Working knowledge of the Charge Description Master (CDM) and its impact on pricing, charging, and reimbursement. Demonstrated analytical skills with the ability to extract, interpret, and present complex data sets using Excel and other reporting tools. Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job‑specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case‑by‑case basis. EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values. #J-18808-Ljbffr Care New England