Revenue Integrity Analyst III

Responsibilities Serve as a senior subject matter expert in revenue integrity, providing advanced analysis, payer escalation support, and leadership for complex revenue cycle issues. Lead high-level charge capture initiatives, payer strategy escalations, and systemwide denial prevention efforts. Mentor junior analysts, partners with cross-functional leaders, and drive enterprise-wide initiatives that ensure accurate billing, regulatory compliance, and optimized net revenue performance. Leads investigations of systemic billing edits, high-dollar revenue discrepancies, and specialty‑specific coding risks; develops recommendations for long‑term corrective action. Designs and oversees charge capture improvement projects across multiple service lines; ensures sustainable improvements to documentation, charging practices, and Epic workflows. Develops advanced dashboards and predictive analytics models to monitor denial trends, charge lag, missed charges, and net revenue opportunities; provides actionable insights to senior leadership. Performs complex cost‑benefit analyses to evaluate the financial impact of revenue improvement proposals, payer policy changes, and operational redesigns. Leads payer and internal audits, ensuring thorough documentation, effective responses, and sustainable corrective actions; supports escalations of payment policy or denial issues to senior payer relations leadership. Collaborates with Compliance, Legal, and CDM teams to establish governance structures, implement billing corrections, and ensure adherence to corporate initiatives and regulatory requirements. Serves as the senior analyst for multiple high-volume or high-risk service lines; acts as a system resource on complex reimbursement and compliance challenges. Leads quarterly and ad‑hoc reviews with operational executives to present findings and recommendations; mentors Analysts I and II, providing technical guidance, coaching, and quality assurance for their work. Requirements Seven (7) years of progressive experience in revenue cycle, billing compliance, healthcare reimbursement, or financial analysis and one of the certifications listed below OR Ten (10) years of progressive experience in revenue cycle, billing compliance, healthcare reimbursement, or healthcare financial analysis in lieu of education and certification. Bachelor’s degree in Finance, Healthcare Administration, Business, Nursing, or related field in lieu of experience and certifications. AHIMA‑CCS or AAPC‑CPC or CMC or AHIMA‑RHIT or AHIMA‑RHIA in lieu of Bachelor’s degree. Expert‑level knowledge of hospital and physician billing, coding, and reimbursement methodologies. Proven experience leading revenue integrity projects with measurable ROI. Advanced proficiency with Epic and revenue cycle analytics platforms. Demonstrated ability to analyze complex financial data and communicate strategic insights. Strong leadership, coaching, and cross‑functional collaboration skills. Strategic problem‑solving with enterprise‑level perspective. Ability to lead systemwide initiatives and build governance structures. Strong presentation skills for senior executives and cross‑functional committees. Effective mentor and coach for junior staff. Results‑driven with proven track record of improving net revenue and compliance. Regularly required to sit, work on a computer, and attend meetings in person and virtually. Requires manual dexterity, visual acuity, and ability to communicate effectively. May require occasional travel between facilities for leadership meetings or audits. Hybrid office‑based role with flexibility as approved by department leadership. Minimal exposure to clinical environments; primary exposure to office and virtual meeting settings. Experience in payer contract analysis and denial prevention strategies strongly preferred. #J-18808-Ljbffr Jobtailor