Revenue Integrity Analyst (Medical Coding)
About The Position
The Revenue Integrity Analyst (Medical Coding) supports accurate documentation, compliant coding, and optimized charge capture within MHS GENESIS, the Military Health System’s enterprise EHR. The role ensures correct configuration of revenue cycle workflows and reduces revenue leakage through data analysis, system support, and cross‑functional collaboration. Responsibilities of this role are as follows, to include but not limited to: System Configuration & Support: Validate and troubleshoot MHS GENESIS revenue cycle build, including coding workflows, charge capture, charge router logic, and billing integrations. Ensure accurate mapping of CPT, ICD‑10, HCPCS, modifiers, and charge codes. Data Analysis: Analyze clinical and financial data to identify coding variances, charge gaps, and revenue integrity issues. Produce reports, track KPIs, and recommend solutions. Claim & Denial Management: Investigate edits, rejections, and denials; identify root causes; and coordinate fixes with coding, clinical, revenue cycle, and IT teams. Charge Capture Optimization: Reconcile clinical activity against charges, validate CDM mapping, and ensure charges flow correctly across departments. Auditing & Compliance: Conduct chart‑to‑bill audits, confirm coding accuracy, and ensure alignment with DHA, CMS, and federal regulations. Training & Collaboration: Educate clinicians and RCM staff, serve as liaison between operational and build teams, and support revenue improvement workgroups.
Requirements
- Must be able to OBTAIN and MAINTAIN a Federal or DoD "PUBLIC TRUST"; candidates must obtain approved adjudication of their PUBLIC TRUST prior to onboarding with Guidehouse. Candidates with an ACTIVE PUBLIC TRUST or SUITABILITY are preferred.
- Bachelors Degree
- FOUR (4) or more years of Revenue Cycle Management (RCM) build experience, including troubleshooting, system reconfiguration, and/or project management.
Nice To Haves
- Bachelor’s Degree in Business, Management, Healthcare Administration, Business Analysis, Statistics, or related field
- Experience with Oracle/Cerner EHR RCM Solution initial builds, trouble shooting, issue resolution, and system reconfigurations.
- Proficiency in CPT, ICD‑10, ICD‑10‑PCS, and HCPCS coding systems.
- Experience performing clinical coding audits, charge capture reviews, or revenue integrity analysis.
- Familiarity with MHS GENESIS, Oracle Health, or similar EHR revenue cycle modules (charge router, encounter coding, professional/hospital billing).
- Understanding of CDM structure, charge routing logic, and billing edits.
- Strong analytical skills with the ability to interpret clinical documentation and financial data.
- Excellent communication skills, with the ability to explain coding and documentation concepts to clinical and administrative stakeholders.
- Experience working within the Military Health System (MHS) or other federal health systems.
- Knowledge of DHA billing policies, TRICARE requirements, and federal reimbursement guidelines.
- Coding certifications such as CPC, CCS, CPMA, RHIT, or RHIA.
- Experience supporting EHR configuration, workflow design, or revenue cycle modernization initiatives.
Responsibilities
- System Configuration & Support: Validate and troubleshoot MHS GENESIS revenue cycle build, including coding workflows, charge capture, charge router logic, and billing integrations.
- Ensure accurate mapping of CPT, ICD‑10, HCPCS, modifiers, and charge codes.
- Data Analysis: Analyze clinical and financial data to identify coding variances, charge gaps, and revenue integrity issues.
- Produce reports, track KPIs, and recommend solutions.
- Claim & Denial Management: Investigate edits, rejections, and denials; identify root causes; and coordinate fixes with coding, clinical, revenue cycle, and IT teams.
- Charge Capture Optimization: Reconcile clinical activity against charges, validate CDM mapping, and ensure charges flow correctly across departments.
- Auditing & Compliance: Conduct chart‑to‑bill audits, confirm coding accuracy, and ensure alignment with DHA, CMS, and federal regulations.
- Training & Collaboration: Educate clinicians and RCM staff, serve as liaison between operational and build teams, and support revenue improvement workgroups.
Benefits
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave and Adoption Assistance
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Student Loan PayDown
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Mobility Stipend
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
