Revenue Integrity Analyst

Orthofix

About The Position

The Revenue Integrity Analyst – DME/Healthcare is responsible for driving revenue optimization and minimizing preventable write-offs through comprehensive analysis of denied and uncollectable claims across commercial, federal, and third-party liability payers. This role provides critical insight into denial trends, payer behaviors, and internal process breakdowns across the order-to-cash lifecycle, including intake, documentation, billing, and collections. Through advanced analytics, cross-functional collaboration, and subject matter expertise in DMEPOS reimbursement, the Revenue Integrity Analyst identifies root causes of revenue leakage and delivers actionable recommendations to improve operational workflows, enhance documentation accuracy, and strengthen payer alignment. This position plays a key role in supporting financial performance, ensuring compliance with payer requirements, and advancing revenue cycle excellence through data-driven decision-making and continuous process improvement.

Requirements

Bachelor’s degree in Healthcare Administration, Business, or related field, or equivalent combination of education and experience
Minimum of 3 years of experience in healthcare revenue cycle, preferably within DMEPOS, medical device, or related reimbursement environments
Strong understanding of the full claims lifecycle, including billing, adjudication, denials management, and appeals processes
Experience reviewing claims for documentation accuracy, compliance, and payer alignment (non-financial audit focus)
Familiarity with commercial, federal, and third-party liability payer requirements and common denial drivers
Strong analytical and problem-solving skills, with the ability to identify trends and translate findings into actionable insights
Proficiency in Microsoft Excel and/or reporting tools for data analysis, visualization, and presentation
Effective communication skills, with the ability to collaborate across cross-functional teams and present findings to leadership
High attention to detail with the ability to manage multiple priorities in a fast-paced, deadline-driven environment

Nice To Haves

Certified Professional Biller (CPB) – AAPC
Certified Professional Coder (CPC) – AAPC
Certified Revenue Cycle Representative (CRCR) – Healthcare Financial Management Association
Certified Revenue Integrity Professional (CRIP) – Healthcare Financial Management Association
Direct experience in DMEPOS billing and reimbursement, including familiarity with HCPCS (E-codes) and Medicare/DME MAC policies
Experience in denials management, appeals, or revenue integrity functions within a healthcare setting
Knowledge of payer policy interpretation, including Local Coverage Determinations (LCDs), coverage criteria, and prior authorization requirements
Demonstrated experience identifying root causes and driving corrective actions across intake, documentation, and billing workflows
Understanding of payer contracting concepts, including allowable rates, coordination of benefits, and out-of-network considerations
Advanced Excel skills, including pivot tables, data modeling, and trend analysis
Experience working cross-functionally within Sales, Operations, and Reimbursement teams in a matrixed organization
Ability to translate complex reimbursement and operational issues into clear, concise, executive-level insights and recommendations

Responsibilities

Conduct detailed reviews of third-party claims (including commercial, federal, and third-party liability payers) classified as uncollectable to validate root causes and confirm all appropriate collection efforts have been exhausted
Analyze denial drivers, including but not limited to timely filing, documentation deficiencies, authorization issues, eligibility errors, benefit exclusions, non-contracted status, coding or place-of-service inaccuracies, and invalid or incomplete prescriptions
Differentiate between payer-driven denials and internal operational breakdowns across order intake, clinical documentation, billing, and follow-up workflows
Identify, categorize, and quantify denial and write-off trends across payers, product lines, and internal functional areas to uncover systemic revenue leakage
Develop and deliver recurring reporting (monthly and quarterly) highlighting key findings, financial impact, and prioritized, actionable recommendations
Present insights and strategic recommendations to Order-to-Cash, Revenue Cycle, and Sales leadership, translating complex reimbursement issues into clear, executive-level guidance
Partner cross-functionally with Order Processing, Billing, Sales, and Payer Relations teams to address root causes and implement sustainable process improvements
Support the implementation, monitoring, and effectiveness tracking of corrective actions, including training initiatives, workflow redesign, and documentation standardization
Maintain a strong working knowledge of payer policies, coverage criteria, and DME billing requirements to ensure accurate analysis and recommendations
Contribute to continuous improvement initiatives focused on denial reduction, revenue recovery, and operational efficiency across the revenue cycle