The Billing Integrity Analyst provides professional expertise to support Medicare billing compliance across facility and professional billing processes. This role reviews audit-related compliance processes, partners with IT to ensure proper builds and edits are in place, and communicates billing requirement updates to staff.
The position supports Revenue Cycle leadership with policy and procedure input, researches new and updated Medicare and payer requirements, and evaluates complex claim edits and payer denials. It also works closely with the health system compliance department to protect the integrity of the billing process and serves as a lead resource for billing compliance across clinical departments.
Key responsibilities include maintaining a tracking system for reviewed documentation and outcomes, preparing and presenting audit and testing reports, monitoring regulatory updates, and collaborating with Revenue Integrity, Denials Management, and other internal teams.
Minimum Requirements
- Bachelor's degree
- Seven years of relevant experience may be considered in lieu of the degree requirement
- At least 3 years of experience in hospital or professional billing, medical records, or charge audit
- General knowledge of billing and coding rules and regulations for governmental and managed care payers
Preferred Qualifications
- Bachelor's degree
- Manager or coordinator experience
- 2+ years of reporting analysis experience
- CPC, RHIT, or equivalent coding certification
- MS Office experience
Additional Requirements
- Strong knowledge of coding and billing regulations and guidelines
- Excellent communication skills
- Ability to work independently and as part of a team
- Attention to detail and strong organizational skills
- Ability to serve in a lead role across teams
- Flexibility in responsibilities and work schedule
- Applicants must reside in one of the following states: Alabama, Arizona, Connecticut, Delaware, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia, or Wisconsin
Location
South Carolina, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
1 month ago