Revenue Integrity Analyst

Job Summary: The Revenue Integrity Analyst collaborates with clinical departments, coding, finance, and Information Technology (IT) to resolve discrepancies, reduce revenue leakage, and maintain charge integrity with regulatory and payer requirements. This role partners with charge generating departments to ensure accurate, timely charge capture, revenue reconciliation and optimal reimbursement across the organization.

Minimum Education: High school diploma or GED. Bachelor’s degree in Business, Finance, Healthcare Administration, or related field, preferred.

Licensure, Registration and/or Certification: None. Certified Revenue Cycle Representative (CRCR) from Healthcare Financial Management Association (HFMA) and Epic Certifications (Resolute Hospital Billing, Resolute Professional Billing, Revenue Integrity), preferred.

Work Experience: Minimum 3 years of Financial Analysis, Healthcare Revenue Cycle, Revenue Integrity, or Reimbursement experience.

Knowledge, Skills, and Abilities: Knowledge of Microsoft 365 and other applicable software. Strong knowledge of Epic, including basic reporting tools, system navigation, and workflows. Working knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding Systems (HCPCS), revenue codes, Ambulatory Payment Classification (APC)/Diagnosis-Related Group (DRG) concepts, and payer billing rules. Knowledge of healthcare regulatory requirements. Strong organizational skills and attention to detail. Excellent communication skills, both written and verbal that present clear and concise information. Sound ability to analyze financial and operational data to support decisions. Ability to work independently and collaboratively in a fast-paced environment, managing multiple priorities with competing deadlines.

Essential Functions and Responsibilities: Performs routine reviews of charges and documentation, to identify missed revenue. Partners with charge generating clinical departments to ensure Charge & Revenue Reconciliation is consistently performed. Assists clinical and operational teams with the resolution of charge discrepancies and denials related to charge capture. Partners with clinical and operational areas to evaluate new services or procedural updates and ensure appropriate charge trigger is efficient. Conducts root cause analysis and provides data driven recommendations for revenue cycle departments. Provides basic education to departments regarding charge capture expectations, regulatory updates, and revenue reconciliation. Participates in workflow improvement projects impacting charge capture and reimbursement. Communicates findings and trends to management and relevant departments. Maintains knowledge of payer policies and compliance requirements.

Decision Making: Independent judgment in making decisions involving non-routine problems under general supervision.

Working Relationships: Works directly with patients and/or customers. Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

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