Revenue Integrity Analyst

Department: Business Office

Hours: Fulltime, Day Shift, Monday-Friday

Description:

Position Overview: The Revenue Integrity Analyst is responsible for ensuring the hospital’s revenue capture, charge structure, and reimbursement processes are accurate, compliant, and optimized. This position serves as the operational link between clinical departments, coding, billing, and finance, analyzing data, identifying revenue leakage, and driving improvement in charge capture, pricing, and denials performance.

Essential Duties and Responsibilities:

Charge Capture & Chargemaster Oversight

• Maintain, audit, and update the hospital and clinic charge description master (CDM) to ensure all charges are compliant with payer and CMS requirements.
• Coordinate with department leaders and IT to ensure accurate charge capture, CPT/HCPCS code mapping, revenue code alignment, and pricing consistency.
• Evaluate new services and equipment for appropriate charge setup, pricing, and reimbursement potential.
• Conduct periodic charge reviews to identify under- or over-charging, missing charges, and documentation gaps.
• Collaborate with clinical, coding, and billing teams to educate staff on charge capture workflows.

Revenue Integrity & Analytics

• Monitor and analyze key revenue cycle metrics, including late charges, gross and net revenue trends, charge lag, and DNFB.
• Develop dashboards or reports to track revenue integrity performance indicators by department or service line.
• Lead root-cause analyses on revenue leakage and recommend corrective action plans.
• Partner with Finance to support month-end close processes, ensuring charge and adjustment accuracy for reporting and cost accounting.
• Support annual pricing reviews and assist in payer contract modeling for reimbursement validation.

Denials & Reimbursement Management

• Track, trend, and analyze claim denials to identify systemic issues and coordinate with coding, billing, and registration teams to prevent recurrence.
• Maintain a denials database and provide feedback to departments to improve first-pass claim accuracy.
• Collaborate with Managed Care and Finance to review payer policies and reimbursement patterns.
• Lead multidisciplinary denials review meetings and present findings to leadership with actionable recommendations.

Compliance & Education

• Ensure all charge capture, billing, and reimbursement practices comply with federal and state regulations, including CMS and OIG guidelines.
• Serve as an internal consultant to departments regarding charge capture, coding, and documentation integrity.
• Develop and deliver training sessions for department leaders and revenue cycle staff.
• Support external audits and assist with internal audit initiatives related to billing and reimbursement.

Minimum Education and/or Experience Required:

• Associate’s degree required; equivalent experience in revenue cycle operations may be considered in lieu of formal education.
• Minimum of 3–5 years of experience in hospital revenue integrity, charge master maintenance, denials management, or other revenue cycle operations (critical access experience preferred).
• Strong working knowledge of Medicare/Medicaid reimbursement, billing regulations, and compliance standards.
• Proficiency in Meditech EMR and Microsoft Excel; familiarity with analytics tools (e.g., Power BI) preferred.
• Ability to translate complex financial and clinical data into actionable insights.
• Excellent communication and collaboration skills across departments.

Additional Qualifications:

• Strong attention to detail and commitment to accuracy.
• Demonstrated integrity and ability to work independently with minimal supervision.
• Self-motivated with the initiative to identify and complete tasks proactively.
• Strong problem-solving and critical-thinking abilities.
• Excellent organizational skills with the ability to prioritize assignments and manage time effectively.
• Must be able to read, write, comprehend, and verbally communicate in English fluently.
• Adaptive and flexible; embraces change with a positive and solution-oriented attitude.
• Ability to operate technologies and equipment associated with this position.
• Must have a service mindset and a commitment to continuous learning.
• Ability to work outside of regularly scheduled hours if needed.
• Mandatory Reporter.

Licensure/Certification Required:

• CRCR (Certified Revenue Cycle Representative) certification is required, or obtained within 3 months of starting.

Physical/Cognitive Requirements:

• Sit: Constant
• Stand: Frequent
• Walk: Frequent
• Lift:
  • 10 pounds Frequent
  • 25 pounds: Occasionally
  • 50 pounds*: Occasionally
  • 75 pounds*: Never
  • Greater than 100 pounds*: Never
• Carry:
  • 10 pounds: Frequent
  • 25 pounds: Occasionally
  • 50 pounds*: Occasionally
  • 75 pounds*: Never
  • Greater than 100 pounds*: Never
• Push/Pull:
  • 10 pounds: Occasionally
  • 25 pounds: Occasionally
  • 50 pounds*: Occasionally
  • 75 pounds*: Occasionally
  • Greater than 100 pounds*: Occasionally
• Squat/Kneel/Crouch: Frequent
• Climb: Occasionally
• Balance: Occasionally
• Twist: Frequent
• Bend/Stoop: Frequent
• Crawl: Frequent
• Grasp/Grip: Constant
• Talk: Constant
• Hear: Constant
• See: Constant

• Anything greater than 50 pounds- assist of two or more, or mechanical lift are required.

Environmental Factors:

• May be exposed to communicable diseases due to working in a health care environment.
• Works in a well-illuminated climate-controlled environment.
• Work environment is comfortable, with minimal exposure to physical hazards.
• Moderate noise level when machines/equipment in use but typically quiet environment.

Organizational Relationships:

Reports to: Chief Financial Officer (or Revenue Cycle Director)

Employees supervised: None