Senior Revenue Integrity Analyst

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

📋 Description

• Offer subject matter expertise in charge capture, CDM application, compliance, and reimbursement.

• Lead audits, support governance efforts, and promote revenue optimization initiatives across clinical departments.

• Oversee the accuracy of departmental charge capture through work queue analysis and reconciliation reports.

• Identify gaps in charge capture, workflow challenges, and risks of systemic revenue loss.

• Provide direction, training, and educational support to clinical departments.

• Collaborate with the CDM team on updates and suggest enhancements.

• Perform pre- and post-bill audits to confirm charge mappings and billing regulations.

• Analyze trends and root causes impacting reimbursement, compliance, and financial performance.

• Quantify revenue at risk and evaluate the financial ramifications of charge-related issues.

• Create corrective action plans to enhance revenue initiatives.

• Ensure compliance with CMS and regulatory standards.

• Assist with annual CPT/HCPCS updates.

• Work in partnership with Coding, IT, Finance, Compliance, and leadership to address issues and enhance processes.

• Support governance committees.

• Generate reports and dashboards, providing data-driven recommendations to leadership.

• Execute other assigned duties.

⛳️ Requirements

• Bachelor’s degree required.

• 5+ years of experience in hospital revenue cycle, charge capture, or CDM.

• Relevant certifications and proven experience may substitute for the required degree.

• Advanced understanding of CPT/HCPCS and reimbursement processes.

• Expertise in CDM structure and its clinical application.

• Strong background in auditing and compliance.

• Capability to assess the financial impact of charge-related issues.

• Experience in workflow redesign and optimization.

• Advanced skills in Excel and data analysis.

• Ability to lead training and educational initiatives.

• Excellent communication skills across clinical and executive teams.

• Knowledge of CMS, Medicaid, and payer regulations.

• Experience with dashboards and reporting.

• Ability to read, write, reason, converse, use a keyboard, and drive.

• Preferred certifications: CPC, CCS, RHIT/RHIA, or Epic Certification.

🏝️ Benefits

• Full-time employment.

• Monday–Friday daytime schedule.

• Opportunities for professional development and career advancement.

• Training and educational initiatives.

• Equal opportunity employment.