Revenue Integrity Analyst

TEKsystems•Chesapeake, VA

2d•$40 - $42•Hybrid

About The Position

Position Summary The Revenue Integrity / Charge Capture Analyst supports accurate charging, coding edits, and revenue capture across multiple departments. This role manages multiple work queues, reviews coding and billing edits, identifies missed or incorrect charges, and partners with clinical departments and billing teams to resolve issues, prevent revenue leakage, and improve processes. HR JD-Position Summary The Revenue Integrity Specialist supports accurate hospital billing by reviewing charges against medical record documentation. This role audits itemized charges, resolves billing edits, assigns appropriate modifiers, and ensures compliance with payer requirements. The Specialist works closely with revenue‑producing departments, billing teams, Health Information Management, and audit partners to identify missed charges, prevent denials, and improve charge capture processes.

Requirements

CPC
Knowledge of ICD‑10‑CM, CPT, and HCPCS coding systems
Familiarity with Medicare, Medicaid, and commercial payer guidelines
Understanding of charge capture, billing audits, and revenue integrity processes
Strong analytical, organizational, and problem‑solving skills
Ability to communicate effectively with clinical and non‑clinical staff
Attention to detail with a strong focus on accuracy and compliance
Senior Level Coding experience in an acute hospital setting required, with coding ability demonstrated via a skills assessment or a RN with extensive experience as an intensive care unit, emergency department or documentation specialist nurse auditor or an LPN with a combined coding and auditing background.
Experience with health information systems and computer technology required.
Ability to communicate effectively, both verbally and written format.
Must be able to work independently with attention to detail and accuracy

Nice To Haves

RECENT EXPERIENCE IN A HOSPITAL IS WHAT HE IS LOOKING FOR - someone who is familiar with a variety of departments within the hospital. would love a very seasoned coder
ability to interact with people - do analysis - find trends and issues
really wants someone with OUTPATIENT coding experience.

Responsibilities

Manage and prioritize multiple work queues related to coding and charge capture issues.
Review and resolve NCD/LCD edits, MUE edits, and CCI edits to ensure compliant billing.
Perform Charge Capture Audit (CCA) reviews to identify missed charges when departments fail to capture billable services.
Review Observation and Extended Recovery encounters, including infusion and injection charge posting.
Identify, research, and resolve room and board billing issues in coordination with impacted departments.
Work closely with billing teams to follow up on edits, corrections, and denied or delayed claims.
Address and support resolution of patient billing complaints related to charge accuracy.
Educate departments on recurring charge capture, coding, or documentation issues.
Communicate trends and frequent errors to leadership and operational teams to prevent repeat issues.
Serve as a liaison between clinical departments, revenue cycle, and billing to ensure timely resolution of issues.
Handle miscellaneous revenue cycle and charge-related tasks as assigned.
Support daily operational needs related to billing accuracy and revenue integrity.
Audit itemized patient charges against medical records and hospital documentation.
Review observation accounts for carve‑out observation hours, extended recovery, event management, and appropriate charging.
Review documentation to support infusion and injection charge posting.
Perform patient‑requested audits, scheduled quality audits, and random audits as needed.
Ensure charge accuracy and data integrity prior to billing and claims submission.
Research and resolve edited claims for medical necessity and compliance.
Assign appropriate HCPCS codes and modifiers and advise billing staff accordingly.
Review payer remittance advice and remark/reason codes to understand and prevent denials.
Identify denial trends and root causes and support prevention efforts.
Serve as a resource to hospital departments for charging, coding, and billing questions.
Work directly with revenue‑producing departments to identify lost or incorrect charges.
Provide education and guidance on proper charge capture and charging processes.
Collaborate with Patient Financial Services, Health Information Management, Internal Audit, Regulatory Review, and external consultants as needed.
Maintain audit activity reports and track trends and patterns.
Share findings with departments and leadership to support process improvement.
Assist HIM with RAC requests, coding reviews, and denials.
Maintain productivity standards and achieve 95% or greater accuracy.
Attend required orientations, meetings, and continuing education.
Follow confidentiality, compliance, and hospital policies.
Perform other related duties as assigned.