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 & Workflow Validation Validate, test, and troubleshoot MHS GENESIS / Cerner coding workflows, including charge capture pathways, coding forms, charge router logic, and billing system integrations. Ensure accurate mapping and configuration of ICD‑10‑CM, CPT/HCPCS, modifiers, clinical documentation, and charge codes across departments. Utilize HealtheAnalytics / HDI and related tools to identify system defects, data inconsistencies, and workflow gaps. Support enterprise‑level remediation planning, translating findings into actionable build or workflow corrections. Data Analysis & Revenue Integrity Monitoring Analyze clinical, financial, and revenue cycle data to identify coding variances, missing or incorrect charges, and potential revenue leakage. Conduct DNFB risk analysis, charge variance assessments, and trend monitoring across MTFs. Produce reports, interpret dashboards, and communicate revenue integrity insights to leadership, coding teams, and RCM partners. Apply advanced Excel‑based analysis to identify patterns and support data-driven decision-making. Claim Edit & Denial Root Cause Analysis Investigate claim edits, rejections, and denials using tools such as Alpha II / SSI. Perform denial root cause analysis, identifying coding errors, modifier issues, NCCI conflicts, payer policy conflicts, and system configuration defects. Coordinate corrective action with coding, clinical, billing, and IT teams to prevent recurrence. Conduct payer remittance analysis to ensure accurate adjudication and detect reimbursement discrepancies. Charge Capture Optimization Reconcile documentation and clinical activity to ensure charges populate correctly through the encounter, coding, and billing workflow. Validate CDM accuracy, including revenue code mapping, service line alignment, and correct charge routing. Identify department‑specific charge capture risks and recommend workflow corrections to eliminate leakage. Auditing & Compliance Oversight Perform chart‑to‑bill audits to validate documentation quality, coding accuracy, modifier strategy, and billing completeness. Ensure compliance with NCCI edits, LCD/NCD guidance, TRICARE policy, and DHA billing requirements. Monitor adherence to federal and organizational standards for coding and billing integrity. Training, Collaboration & Cross‑Functional Issue Resolution Educate clinicians, coders, revenue cycle teams, and operational leaders on documentation expectations, coding rules, and revenue integrity best practices. Serve as a liaison between clinical operations, RCM, and IT build teams to facilitate accurate issue identification and resolution. Support or lead multidisciplinary workgroups focused on improving documentation, coding accuracy, claim acceptance, and revenue outcomes. Process Improvement & Standardization Recommend enhancements to documentation practices, coding workflows, and charge capture processes to reduce errors and improve financial performance. Identify opportunities for system-wide standardization, workflow redesign, and improved reporting visibility. Support enterprise initiatives to improve audit readiness, reduce denials, and strengthen integrated revenue cycle performance.
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.
- Working knowledge of ICD‑10‑CM, CPT/HCPCS, modifier strategy, NCCI edits, and federal/TRICARE compliance requirements.
- Experience performing clinical coding audits, charge capture reviews, or revenue integrity analysis.
- Familiarity with MHS GENESIS / Cerner, HealtheAnalytics, and associated RCM or billing tools.
- 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 proven ability to drive cross‑functional issue resolution.
- 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.
- Strong skills in Excel, data interpretation, dashboard analysis, and executive‑level reporting.
Responsibilities
- System Configuration & Workflow Validation
- Data Analysis & Revenue Integrity Monitoring
- Claim Edit & Denial Root Cause Analysis
- Charge Capture Optimization
- Auditing & Compliance Oversight
- Training, Collaboration & Cross‑Functional Issue Resolution
- Process Improvement & Standardization
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
