Revenue Integrity Analyst

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Assist in the execution and support of revenue integrity functions, which include charge capture, maintenance of the Charge Description Master (CDM), coding and billing validation, reimbursement integrity, and monitoring of revenue cycle performance.

• Review, maintain, update, and audit the Charge Description Master (CDM), encompassing charge codes, revenue codes, modifiers, pricing, and charge routing logic.

• Assess charging vehicles and workflows to guarantee timely and precise charge capture.

• Monitor billing edits, charge discrepancies, late charges, missing charges, and unbilled accounts; investigate and resolve issues prior to claim submission whenever possible.

• Examine medical records and documentation to confirm charges, coding accuracy, and compliance.

• Detect and address revenue leakage, underpayments, overpayments, and discrepancies related to charges.

• Assist in underpayment management and denial prevention through root cause analysis.

• Execute audits on charge capture, coding, and documentation across clinical departments and service lines.

• Keep abreast of regulatory changes, payer policies, and billing regulations, converting requirements into operational guidance.

• Act as a liaison between clinical departments, providers, and operational leaders.

• Offer education and direction on charge capture, documentation, and billing practices.

• Collaborate with teams in Coding, Revenue Cycle, Finance, and Managed Care.

• Track and report on revenue integrity KPIs, such as charge lag, missing charges, audit results, and billing error patterns.

• Generate routine and ad hoc reports while supporting revenue integrity enhancement initiatives.

• Aid the Revenue Cycle, Coding, Finance, and Managed Care teams with special projects and operational needs.

• Manage Protected Health Information (PHI) in accordance with organizational policies and regulatory standards.

⛳️ Requirements

• A Bachelor’s degree in healthcare administration, Finance, Business, Nursing, or a related field, or an equivalent combination of education and experience.

• A minimum of three (3) to five (5)+ years of experience in revenue integrity, revenue cycle operations, charge capture, coding, or billing.

• In-depth knowledge of CDM management, charge capture practices, and revenue cycle workflows.

• Advanced comprehension of CPT, HCPCS, ICD-10 coding, NCCI edits, and reimbursement methodologies, including DRG, OPPS, and managed care.

• Capability to review and interpret payer contracts, billing guidelines, and regulatory requirements.

• Strong analytical and problem-solving abilities, along with audit skills and meticulous attention to detail.

• Excellent written and verbal communication skills, with the capacity to educate and collaborate with clinical and operational stakeholders.

• Proficiency in Microsoft Excel and other reporting tools; experience with Epic is preferred.

• Ability to work autonomously, prioritize competing demands, and adapt within a small-facility, multi-role environment.

• No license or certification is required.

• Competence in managing Protected Health Information (PHI) in compliance with organizational policies and regulatory requirements.

• Capability to fulfill the stated physical requirements, with reasonable accommodations as applicable.

🏝️ Benefits

• Fully remote work arrangement.

• Reasonable accommodations may be provided for individuals with disabilities.

• A team engagement culture focused on Compassion, Ownership, Respect, and Excellence.