Revenue Integrity Analyst

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

📋 Description

• Act as a Revenue Integrity resource for designated clinical service lines while collaborating with physicians, clinical staff, operational teams, finance, compliance, coding, patient access, HIM, IT, and revenue cycle stakeholders.

• Examine the connections between the chargemaster (CDM), clinical workflows, Epic configurations, charge capture logic, and subsequent billing processes.

• Maintain the Epic chargemaster content within assigned areas, utilizing knowledge of charge capture, charge router logic, billing workflows, reimbursement, Epic revenue cycle capabilities, and charging features within related Epic clinical modules.

• Conduct comprehensive assessments of scheduling, documentation, charge capture, billing, reimbursement, and payment workflows to pinpoint areas for enhancement.

• Determine the root causes of missed, inaccurate, or incomplete charges and propose and implement corrective measures.

• Collaborate with business and technical teams to refine workflows, system configurations, documentation, and charge capture processes, including increasing automation whenever feasible.

• Analyze operational, financial, and utilization data to spot trends, charging discrepancies, underpayments, missed revenue, and other opportunities for revenue optimization.

• Oversee the changes that have been implemented and evaluate the results to ensure improvements are functioning as intended.

• Assist or lead Revenue Integrity assessments for new clinical programs, technologies, procedures, and service lines.

• Stay informed about federal and state regulations, payer requirements, CPT, HCPCS, ICD-10-CM/PCS, NCCI, Medicare guidelines, and revenue cycle best practices.

• Offer guidance to other analysts when necessary; more experienced candidates may act as subject matter experts or mentors on complex revenue integrity matters.

⛳️ Requirements

• Extensive knowledge of hospital and professional revenue cycle operations, particularly in revenue integrity, charge capture, coding, billing, and reimbursement.

• Strong experience with Epic revenue cycle, including management of chargemaster/CDM, charge router functionality, charging workflows, and workflow optimization.

• Capability to assess clinical and revenue cycle workflows across various service lines and translate findings into actionable recommendations.

• Excellent analytical, critical-thinking, and problem-solving abilities, including the capacity to identify root causes and evaluate financial impacts.

• Proven ability to independently prioritize tasks and collaborate effectively with cross-functional teams in a remote setting.

• Exceptional communication and relationship-building skills, with the ability to articulate revenue cycle and technical concepts to operational leaders and stakeholders.

• Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or a related field, or an equivalent combination of education and experience.

• Progressive experience in Revenue Integrity, encompassing service line assessments, revenue optimization, and cross-functional initiatives.

• Epic Revenue Integrity/Chargemaster certification or demonstrated experience within the Epic Revenue Cycle is preferred.

• Certification in revenue integrity, coding, or revenue cycle (CPC, COC, CCS, CHRI, CRCR, or equivalent) is preferred.

• Clinical experience or clinical education/credentials, such as RN or another relevant clinical background, is advantageous for senior-level candidates.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance plans.

• Competitive salary with performance-based bonuses.

• Opportunities for professional growth and development.

• Flexible work environment and schedule.

• Retirement savings plan with company match.