Revenue Integrity Analyst

R1 RCM

1d•Remote

About The Position

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Revenue Integrity Analyst, you play a key role in maintaining the accuracy, compliance, and efficiency of the charge master. You are responsible for conducting in-depth audits, analyzing complex billing issues and supporting departments in ensuring accurate charge capture and reimbursement. To thrive in this role, you must have a coding background.

Requirements

3+ years coding experience
Hospital coding experience
Experience with Charge Capture Audits

Nice To Haves

CCS, CIRCC, COC, CPC or equivalent preferred
EPIC experience preferred

Responsibilities

Prepares Excel analysis, including V-Lookups and pivot tables.
Gathers and compiles data in a systematic fashion, clearly documenting assumptions, and validating accuracy of information to resolve inconsistencies.
Evaluate and implement charge requests with appropriate CPT/HCPCS codes, revenue codes, and pricing, ensuring alignment with clinical services and coding/billing guidelines.
Conducts Charge Capture Audits: Review and analyze patient records, billing data, and financial statements to ensure charge and coding compliance.
Identify discrepancies or errors and develop action plan for future state resolution
Analyzes data to identify likely relationships, summarizes data and prepares summary materials for discussion with clinical and finance teams.
Monitor regulatory changes and payer updates that may impact charge master and revenue integrity.
Collaborates with various departments to resolve CDM or RI discrepancies (Utilization Management (UM), Clinical Documentation Integrity (CDI), RCM, Coding Services, Clinical Departments, and Health Information Management (HIM)).
Serve as a liaison during system upgrades, new service implementation, and pricing reviews.