Revenue Integrity Analyst

Avera•Sioux Falls, SD

19h•$26 - $38

About The Position

The Revenue Integrity Analyst is responsible for enhancing financial performance, ensuring accurate charge capture, and securing appropriate reimbursement across the revenue cycle. This role combines expertise in analytics, charge auditing, and payment integrity to support strategic decision-making, operational efficiency, and compliance. The analyst collaborates with clinical, billing, coding, IT, and payer relations teams to identify trends, resolve discrepancies, and drive continuous improvement across Hospital Billing (HB) and Professional Billing (PB) services.

Requirements

The individual must be able to work the hours specified.
To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.
Associate's in Healthcare Administration, Finance, Business Analytics, or related field and/or 2-3 years of experience in healthcare revenue cycle analytics, charge auditing, or payment integrity.
Two to three years experience in healthcare revenue cycle analytics, charge auditing, or payment integrity.
Knowledge of healthcare billing, denial management, and/or payer reimbursement methodologies.

Nice To Haves

Bachelor's
Certified Revenue Cycle Representative (CRCR) - Healthcare Finance Management Association (HFMA) Upon Hire or Certified Specialist Payment & Reimbursement (CSPR) - Healthcare Finance Management Association (HFMA) Upon Hire
Proficiency in data visualization tools (e.g. Power BI, Tableau) and Excel
Experience with Epic reporting tools (e.g., SlicerDicer, Reporting Workbench, Clarity, billing and contract modules)

Responsibilities

Design, maintain, and enhance dashboards and scorecards for denials, write-offs, payer performance, and charge activity.
Analyze trends and translate complex data into actionable insights for stakeholders.
Conduct audits and Revenue Guardian checks to validate charge accuracy and completeness.
Perform payer-specific audits and monitor ED Discharge and Charge Tracker Reports.
Monitor and resolve Discharged Not Billed (DNB) accounts to ensure timely claim submission.
Investigate denials and underpayments, identify root causes, and recommend process improvements.
Manage appeals for underpaid claims, track outcomes, and report on recovery efforts and payment trends.
Review high-dollar write-offs for appropriateness and escalate discrepancies as needed.
Oversee Post-Service Single Case Agreements (SCAs) to ensure reimbursement accuracy and adherence to contract terms.
Partner with clinical, operational, and payer relations teams to resolve discrepancies and improve documentation.
Participate in audits, strategic initiatives, and projects aimed at financial optimization and revenue integrity.