Revenue Integrity & Financial Analyst (Healthcare – Allergy & Immunology)

The Revenue Integrity & Financial Analyst ensures the organization’s financial performance is optimized through accurate fee schedules, payer reimbursement analysis, and data-driven forecasting. This role bridges billing, finance, and operations—maintaining compliant, competitive charge structures while providing actionable insights into profitability and budget planning. This is a hybrid position in the Austin, TX area.

Key Responsibilities

Fee Schedule & Reimbursement Management

• Maintain and regularly update all CPT charge schedules across payers and subsidiaries.
• Benchmark internal fee schedules against Medicare, commercial payer, and regional competitor rates.
• Monitor annual CPT / RVU / HCPCS updates and recommend adjustments to pricing.
• Audit payers for underpayments and support contract renegotiation initiatives.

Profitability & Margin Analysis

• Calculate cost-per-procedure and contribution margins for allergy testing, injections, biologics, and ancillary services.
• Integrate data from NetSuite, Healix/Medico, and AdvancedMD to align actual results with expected reimbursement.
• Identify opportunities to improve margins through operational efficiency or payer optimization.

Budgeting & Forecasting

• Partner with the CFO to build the annual budget, including revenue, direct expenses, and overhead allocations.
• Create quarterly rolling forecasts based on updated volumes, reimbursement trends, and cost variances.
• Develop models for “what-if” scenarios (e.g., reimbursement changes, staffing shifts, or new location openings).
• Support financial presentations to leadership and ownership.

Reporting & Data Integrity

• Design and maintain dashboards summarizing key metrics (CPT profitability, payer trends, overhead ratios).
• Ensure consistent data mapping between NetSuite, AdvancedMD, and Healix/Medico.
• Collaborate with US Med Billing and internal teams to validate data accuracy and reconciliation.

Qualifications

• Bachelor’s degree in Accounting, Finance, Health Administration, or related field.
• 5+ years of experience in healthcare finance, revenue integrity, or reimbursement analysis (multi-location practice preferred).
• Solid understanding of CPT/HCPCS coding, payer contracting, and revenue cycle workflows.
• Proficiency in Excel / Power BI / SQL (or equivalent data tools).
• Experience with NetSuite, AdvancedMD, or similar EHR and ERP systems preferred.
• Certifications desirable: CRCR (HFMA), CPC (AAPC), or CHFP (HFMA).