Revenue Integrity Analyst

Role Description

The Revenue Integrity Analyst – DME/Healthcare is responsible for driving revenue optimization and minimizing preventable write-offs through comprehensive analysis of denied and uncollectable claims across commercial, federal, and third-party liability payers. This role provides critical insight into denial trends, payer behaviors, and internal process breakdowns across the order-to-cash lifecycle, including intake, documentation, billing, and collections.

Through advanced analytics, cross-functional collaboration, and subject matter expertise in DMEPOS reimbursement, the Revenue Integrity Analyst identifies root causes of revenue leakage and delivers actionable recommendations to improve operational workflows, enhance documentation accuracy, and strengthen payer alignment. This position plays a key role in supporting financial performance, ensuring compliance with payer requirements, and advancing revenue cycle excellence through data-driven decision-making and continuous process improvement.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, or related field, or equivalent combination of education and experience
• Minimum of 3 years of experience in healthcare revenue cycle, preferably within DMEPOS, medical device, or related reimbursement environments
• Strong understanding of the full claims lifecycle, including billing, adjudication, denials management, and appeals processes
• Experience reviewing claims for documentation accuracy, compliance, and payer alignment (non-financial audit focus)
• Familiarity with commercial, federal, and third-party liability payer requirements and common denial drivers
• Strong analytical and problem-solving skills, with the ability to identify trends and translate findings into actionable insights
• Proficiency in Microsoft Excel and/or reporting tools for data analysis, visualization, and presentation
• Effective communication skills, with the ability to collaborate across cross-functional teams and present findings to leadership
• High attention to detail with the ability to manage multiple priorities in a fast-paced, deadline-driven environment

Requirements

• Conduct detailed reviews of third-party claims (including commercial, federal, and third-party liability payers) classified as uncollectable to validate root causes and confirm all appropriate collection efforts have been exhausted
• Analyze denial drivers, including but not limited to timely filing, documentation deficiencies, authorization issues, eligibility errors, benefit exclusions, non-contracted status, coding or place-of-service inaccuracies, and invalid or incomplete prescriptions
• Differentiates between payer-driven denials and internal operational breakdowns across order intake, clinical documentation, billing, and follow-up workflows
• Identify, categorize, and quantify denial and write-off trends across payers, product lines, and internal functional areas to uncover systemic revenue leakage
• Develop and deliver recurring reporting (monthly and quarterly) highlighting key findings, financial impact, and prioritized, actionable recommendations
• Present insights and strategic recommendations to Order-to-Cash, Revenue Cycle, and Sales leadership, translating complex reimbursement issues into clear, executive-level guidance
• Partner cross-functionally with Order Processing, Billing, Sales, and Payer Relations teams to address root causes and implement sustainable process improvements
• Support the implementation, monitoring, and effectiveness tracking of corrective actions, including training initiatives, workflow redesign, and documentation standardization
• Maintain a strong working knowledge of payer policies, coverage criteria, and DME billing requirements to ensure accurate analysis and recommendations
• Contribute to continuous improvement initiatives focused on denial reduction, revenue recovery, and operational efficiency across the revenue cycle

Benefits

• The anticipated salary for this position is between $65,000.00 - $75,000.00 per year, (plus bonus based on performance) and benefits.

Physical Requirements / Adverse Working Conditions

• Must be able to lift and transport products, literature to customer sites repetitively throughout each day.
• Lifting capacity up to approximately 20 to 30 pounds.
• Travel by auto and plane frequently.
• Ability to use PC or laptop computer and cell phone effectively.
• Eyesight and hearing must be correctable to standard level.