The Revenue Integrity Analyst ensures accurate charge capture, coding, and billing across the revenue cycle to optimize reimbursement and maintain compliance. This role involves auditing, data analysis, and collaboration with clinical and financial teams to identify revenue opportunities, support charge reconciliation, resolve denials, and uphold regulatory standards.
Validate charges and coding accuracy by reviewing patient records, charge tickets, and system data.
Maintain and update the Charge Description Master (CDM) and fee schedules.
Conduct audits (prospective and retrospective) to detect errors or omissions.
Perform root cause analysis on denials and revenue variances; implement corrective actions.
Monitor work queues and resolve issues in Epic or other EHR systems.
Ensure compliance with CMS, AMA, CPT, ICD-10, and payer-specific guidelines.
Review CPT updates and coordinate timely implementation.
Prepare reports on audit findings, revenue trends, and reimbursement impact.
Recommend process improvements leveraging data analytics.
Communicate findings and recommendations to leadership through reports and dashboards.
Collaborate with clinical, finance, and IT teams to resolve revenue cycle issues.
Education: High School diploma or equivalent required; Associate degree or higher in healthcare administration, business, finance, HIM preferred.
Experience: 1-3 years in revenue integrity, hospital/professional billing, or healthcare analytics required; Epic experience required.
Licensure/Certification: CPC, COC, and/or RHIA preferred.
Knowledge: Strong understanding of reimbursement, payer policies, CDM, CPT/ICD coding, and audit readiness.
Skills: Advanced Excel and reporting tools (pivot tables, dashboards, data visualization).
Abilities: Effective communication with clinical, operational, and executive stakeholders; ability to work independently on multiple priorities.
Health, dental, prescription, and vision coverage for full-time & part-time employees
Short-term, long-term disability, life & pet insurance
Tuition & certification reimbursement (up to $4,000/year)
Nursing Student Loan Paydown Program (up to $20,000)
403(b) Retirement savings plans with company matching
Continuous earned time accrual