Sr. Revenue Integrity Analyst

Senior RCM Analyst

Location: Fully Remote Job Type: Full-time Experience Level: Mid-Senior Level

Company Overview

Due to significant organizational expansion, we are seeking a highly analytical and detail-oriented Senior Revenue Cycle Management (RCM) Analyst. This is a newly created role designed to bridge the gap between clinical operations and financial outcomes. The primary focus of this position is to perform deep-dive reconciliations of scheduled surgical cases against expected and actual revenue to identify and mitigate variances.

Job Summary

As a Senior RCM Analyst, you will be the architect of revenue integrity across our surgical facilities. You will analyze the entire lifecycle of a claim—from pre-surgical scheduling and charge capture to contract compliance and payment variance analysis. Your mission is to identify revenue leakage, optimize the Chargemaster (CDM), and ensure that every procedure performed is accurately documented, billed, and reimbursed.

Responsibilities

Front-End Revenue Integrity & Charge Capture

• Perform daily charge-to-schedule reconciliations for all surgical facilities, ensuring operative schedules align with posted charges.

• Manage the Chargemaster (CDM), overseeing the accuracy of CPT/HCPCS, revenue codes, and annual pricing updates.

• Reconcile high-acuity implants, devices, and supplies (Spine, Ortho, Cardiac, Bariatric) against vendor invoices and physician preference cards.

• Audit charge capture for commonly missed items, including add-on codes, bilateral modifiers, and segmental instrumentation.

Mid-Cycle Validation & Contract Compliance

• Model expected reimbursement at the line-item level using payer calculators and contract management tools.

• Proactively flag claims at risk of denial by monitoring payer-specific bundling logic and authorization thresholds.

• Develop Payer Performance Scorecards to identify systematic underpayments and support managed care negotiations.

• Ensure the accuracy of contractual adjustments, write-offs, and allowances across all facilities.

Back-End Variance Analysis & Reconciliation

• Analyze payment variances (under/overpayments) and quantify financial impact by service line and facility.

• Investigate root causes of denials and drive upstream corrective actions to prevent recurrence.

• Collaborate with Revenue Accounting to ensure financial reporting integrity and monitor key metrics (AR aging, DNFB, and Days-to-Bill).

Process Improvement & Strategy

• Identify systemic causes of revenue leakage and implement permanent fixes in charge routing and documentation.

• Build repeatable Revenue Integrity Playbooks for new facility acquisitions and integrations.

• Develop and present executive-level KPI dashboards and EBITDA impact reports.

• Serve as the Subject Matter Expert (SME) for the implementation of AI-powered automation tools for predictive denial prevention.

Qualifications

Minimum Qualifications

• Education: Bachelor’s degree in Health Administration, Finance, Business, or a related field.

• Experience: 3–5 years of progressive experience in healthcare revenue cycle operations (Charge Capture, CDM, or Underpayment Analysis).

• Technical Skills: Advanced Excel proficiency (Data modeling, Power Pivot, VLOOKUP/INDEX-MATCH).

• Knowledge: Strong understanding of CPT, HCPCS, ICD-10, NCCI edits, and Medicare methodologies (DRG, APC, ASC).

Preferred Qualifications

• Certifications: CHRI, CRIP, CPC, CCS, or CRCR preferred.

• Environment: Experience in a multi-facility, ASC, or PE-backed healthcare platform.

• Specialty Knowledge: Direct experience with high-acuity surgical billing (Spine, Ortho, Cardiac) and bill-only workflows.

• Systems: Proficiency in SQL and data visualization tools (Power BI or Tableau).

• Innovation: Experience evaluating or managing AI/automation tools within the RCM space.

Why Join Us?

• Impact: Lead a new function and directly influence the financial health of an expanding organization.

• Flexibility: 100% remote work environment.

• Growth: Opportunity to build processes from the ground up and participate in high-level facility integrations.

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