Revenue Integrity Analyst

Description

Remote eligible position, but must be able to be onsite as needed or required by organization.

PURPOSE STATEMENT

The Revenue Integrity Analyst is responsible for maintaining the integrity of the hospital’s Chargemaster (CDM) and ensuring accurate charge capture, coding support, compliant billing practices, and optimal reimbursement across all hospital departments. This position serves as the primary liaison between Finance, Revenue Cycle, Health Information Management (HIM), Clinical Departments, Compliance, and Information Technology to identify revenue leakage, improve charge accuracy, and support regulatory compliance.

ESSENTIAL FUNCTIONS

Chargemaster Management

• Serve as the primary administrator of the hospital Chargemaster (CDM).
• Maintain all hospital charge descriptions, CPT/HCPCS codes, revenue codes, modifiers, units of service, APC assignments, and pricing.
• Coordinate annual and ongoing CDM updates based on CMS, AMA CPT, HCPCS, payer and regulatory changes.
• Review new services, supplies, pharmaceuticals, and procedures for appropriate charge creation prior to implementation.
• Ensure inactive or obsolete charges are removed appropriately.
• Coordinate annual CPT and HCPCS updates.

Revenue Integrity

• Investigate charge edits and billing errors.
• Analyze denied claims related to charging or billing configuration.
• Collaborate with Denials Management to identify root causes.
• Monitor charge lag and late charge activity.
• Recommend workflow improvements to improve revenue capture.

Perform routine audits to identify:

• Missing charges
• Duplicate charges
• Undercharges
• Overcharges
• Incorrect billing logic
• Revenue leakage

Charge Capture Optimization

• Review departmental charge capture processes.
• Validate that all billable services are captured accurately.
• Work with clinical departments to improve charging workflows.
• Develop standardized charge reconciliation processes.
• Monitor compliance with charging policies.

Meditech Expanse System Maintenance

• Build and maintain charging dictionaries within Meditech Expanse.
• Participate in Meditech upgrades and optimization initiatives.
• Assist with implementation of new clinical documentation and charging workflows.

Coordinate testing of:

• New charge codes
• Pricing updates
• Revenue code changes
• CPT updates
• Modifier logic

Regulatory Compliance

Assist with internal and external audits related to revenue integrity.

Ensure hospital charging practices comply with:

• CMS regulations
• Medicare billing requirements
• Medicaid billing requirements
• National Correct Coding Initiative (NCCI)
• Outpatient Prospective Payment System (OPPS)
• Inpatient Prospective Payment System (IPPS)
• Uniform Billing (UB-04)
• HIPAA
• OIG Compliance Guidance
• Hospital Price Transparency regulations.

Pricing and Financial Analysis

• Maintain hospital pricing methodology.
• Coordinate annual price updates.
• Analyze reimbursement impacts of pricing changes.
• Support strategic pricing initiatives.
• Evaluate reimbursement for new service lines.
• Assist Finance with revenue projections.

Data Analytics

Provide monthly revenue integrity dashboards to leadership

Develop and monitor reports related to:

• Charge lag
• Late charges
• Charge reconciliation
• Missing charges
• Revenue leakage
• CDM accuracy
• Denials by charging issue
• Department charge variance
• Gross revenue trends
• Hospital Price Transparency compliance

Collaboration

Work closely with:

• Patient Financial Services
• Health Information Management
• Coding
• Clinical Departments
• Pharmacy
• Laboratory
• Radiology
• Surgery
• Emergency Department
• Compliance
• Finance
• Information Technology
• Meditech Analysts

Education

• Educate department leaders on compliant charging practices.
• Train staff on new charge capture workflow.
• Develop charging reference materials.
• Communicate CMS and CPT updates affecting departments.

Quality Improvement

Participate in continuous improvement initiatives to:

• Reduce charge errors
• Improve first-pass claim acceptance
• Decrease denials
• Increase net revenue
• Improve charge reconciliation timeliness
• Enhance documentation supporting billing

OTHER FUNCTIONS

• Maintains regular and predictable attendance.
• Performs other essential duties as assigned.
• Ability to travel 20% of the time, including flying and driving rental cars.
• To accommodate travel, must be able to transport own suitcases and portable computer estimated at 25 pounds.

Requirements

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS

• High school diploma or equivalent.
• Bachelor's degree in Healthcare Administration, Health Information Management, Business Administration, Finance, or Accounting is preferred.
• Must possess 3-5 years of experience in one or more of the following: Hospital Revenue Cycle, Chargemaster management, Revenue Integrity, Patient Financial Services, Hospital Billing, and/or HIM/Coding.
• One or more of the following preferred certifications: Certified Revenue Cycle Representative (CRCR), Certified Revenue Integrity Professional (CRIP), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Healthcare Financial Professional (CHFP), RHIA or RHIT.
• Comprehensive knowledge of hospital revenue cycle operations.
• Strong understanding of Chargemaster structure.
• Knowledge of Medicare and Medicaid reimbursement.
• Understanding of APCs, DRGs, CPT, HCPCS, ICD-10, and revenue codes.
• Knowledge of Hospital Price Transparency regulations.
• Experience with charge capture workflows.
• Strong analytical and problem-solving skills.
• Excellent Excel skills.
• Ability to analyze large datasets.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities.
• Detail-oriented with strong organizational skills.
• Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the hospital/clinic.
• English sufficient to provide and receive instructions/directions.

PHYSICAL/MENTAL REQUIREMENTS

• Remote eligible position, but must be able to be onsite as needed or required by organization.
• Ability to attend meetings throughout the organization.
• Must be able to sit and stand, intermittent 8 to 10 hours a day.
• Must be able to use standard office equipment, including the telephone and computer keyboard.
• Continuously works under pressure of near 100% accuracy while meeting inflexible deadlines.
• Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing.
• Frequently stands, walks, sits and utilizes eye/hand coordination and color definition.
• Occasionally reaches above shoulder, regularly required to lift and/or carry up to 20 lbs.
• Occasionally walks on uneven surfaces.