Revenue Integrity Analyst

The Revenue Integrity Analyst uses advanced knowledge of coding, CDM, charge capture, and auditing to solve complex charging scenarios, provide education and assistance to operational departments, support team members, and develop processes and procedures to ensure accurate and timely capture of all chargeable procedures. This role also provides high-level support in working advanced outpatient coding edits and auditing charges for service lines with potential missed revenue opportunities.

Responsibilities

• Enter charges accurately on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines.
• Resolve Epic Account, Charge Review, and Claim Edit work queue items, including NCCI, MUE, PTP, and OCE edits.
• Evaluate the Charge Description Master (CDM), including revenue codes, descriptions, CPT/HCPCS codes, and pricing.
• Audit and reconcile charges against clinical documentation, coding rules, and charging methodologies.
• Work with external vendors to identify charge capture opportunities and missed charges.
• Analyze trends and propose solutions to improve processes and support training efforts.
• Serve as a subject matter expert for team members and assist with account resolution.
• Maintain accuracy, quality, timeliness, and productivity standards.
• Research payor requirements for compliant billing, timely payment, and maximum reimbursement.
• Support process improvement initiatives related to revenue enhancement and charge integrity.