Revenue Integrity Analyst

Revenue Integrity Analyst The Revenue Integrity Analyst ensures accurate and compliant patient billing by analyzing charge capture, coding, and claims processes, identifying revenue leakage through audits and data analysis, and implementing improvements via education and system updates, working with clinical and financial teams to optimize reimbursement and maintain payer compliance. Responsibilities Validate annual pricing updates to the Charge Description Master (CDM) to ensure accuracy and optimize reimbursement. Collaborate across departments (clinical, IT, billing, coding) to resolve issues and implement solutions. Stay updated on payer regulations (Medicare, commercial) and educate staff on guidelines. Conduct audits, analyze claim data, review charge capture, and investigate variances. Perform post‑implementation audits to confirm system updates and CDM changes generate appropriate reimbursement. Develop and monitor KPIs to identify Revenue Integrity initiatives and track performance. Create standardized charge capture processes including daily reconciliation and reporting for all clinical departments. Perform root cause analysis from charge capture reconciliation, audits, and CDM to resolve payer denials, coding/billing edits, and delays. Develop and implement process improvements to streamline workflow, automate processes, and enhance CDM integrity. Quantify metrics from improvements such as incremental revenue, cost savings, and CDM compliance. Create reports, track trends, and present findings to leadership and clinical departments; develop dashboards of financial activity. Support the Denials Governance Committee, focusing on denial prevention and performance improvement. Support the Revenue Integrity Team and strategic Revenue Cycle plan by ensuring services rendered are accurately reported and reimbursed while maintaining regulatory and payer compliance. Qualifications Bachelor's Degree (required). High School Diploma (required). Experience in revenue integrity, revenue cycle, billing, coding, or related field. Knowledge of payer regulations (Medicare, commercial) and coding guidelines. Strong analytical and audit skills. Excellent communication and training abilities. Collaborative working style across clinical, IT, billing, and finance teams. Compensation Pay based on experience, starting at $54,808.00 with an estimated range of $54,808.00 to $84,947.20. Full‑time, 40 hours a week. Works under guidance of Supervisor. Coordinates and implements projects and personnel‑related activities. Interacts with medical staff, provider offices, nursing, ancillary departments, and outside organizations. #J-18808-Ljbffr