Revenue Integrity Analyst

This role has six (6) positions available. Reporting to and under the direction of the Director of Revenue Integrity, the Revenue Integrity Analyst serves as a subject matter expert responsible for supporting accurate, compliant, and complete revenue capture across clinical and financial processes, from the provision of patient care through final bill generation.

The Revenue Integrity Analyst utilizes Epic and other revenue cycle systems to research patient accounts, review charge and billing activity, manage work queues, investigate and resolve charge-related edits, analyze revenue integrity trends, and monitor key performance indicators. The Analyst collaborates with physicians, nurses, patient access, coding, billing, finance, and other clinical and operational teams to identify and resolve revenue capture issues.

Leveraging system tools and data-driven analysis, the Analyst identifies opportunities to improve charge capture accuracy, reduce claim edits and denials, optimize revenue cycle performance, mitigate revenue leakage, and support accurate, compliant reimbursement and revenue integrity practices SPECIFIC SKILLS NEEDED

• Knowledge of hospital and/or physician revenue capture, billing, and revenue cycle processes.
• Knowledge of healthcare code sets, including CPT, HCPCS, and ICD-10, as well as NCCI edits and Medicare LCDs/NCDs.
• Understanding of reimbursement methodologies, including DRG, OPPS, HCC, and managed care.
• Ability to review and interpret payer requirements, contracts, billing guidelines, and applicable state and federal regulations.
• Proficiency with Epic Revenue Cycle functionality, including working Epic work queues, navigating patient accounts, clinical documentation, and charge information, researching charge-related edits, and resolving edits through appropriate Epic workflows.
• Strong analytical and problem-solving skills with a high degree of attention to detail and accuracy.
• Ability to identify trends in Epic and use data and Revenue Integrity KPIs to support revenue improvement and process optimization.
• Ability to effectively communicate with clinical, financial, coding, billing, and operational stakeholders.
• Ability to provide education and training related to charge capture, coding, billing, documentation, Epic workflows, and compliance.
• Ability to work independently while functioning effectively as part of a team in a fast-paced environment. EDUCATION/EXPERIENCE/TRAINING Required:
• Three (3) or more years of experience in a healthcare environment working with a chargemaster, charge capture, and/or revenue cycle processes.
• Hands-on experience working in Epic, including Revenue Cycle workqueues and the research, analysis, and resolution of billing and/or charge-related edits.
• Associate degree in Healthcare Administration, Finance, Business, Nursing, or a related field, or an equivalent combination of education and experience. Preferred:
• Bachelor’s degree in Healthcare Management, Finance, Business, Nursing, or a related field.
• Applicable professional certification through AHIMA (CCA, CCS, RHIT) or AAPC (CPC, CIC, COC).
• Epic certification in a Revenue Cycle application, preferably Hospital Billing (HB), Professional Billing (PB), or a related charging, charge capture, or Revenue Cycle module.