Revenue Integrity Analyst

Children’s Hospital of Philadelphia•Philadelphia, PA

1d•Remote

About The Position

The Revenue Integrity Analyst plays a pivotal role in ensuring accurate charge capture, billing and reimbursement across our revenue cycle. You’ll collaborate closely with the Revenue Integrity Specialist (RIS), Revenue Integrity Auditors, and the CDM team — and serve as the key liaison between the RIS and their assigned clinical departments. In this visible, impactful role you’ll help improve internal processes and policies turning them into practical, compliant workflows that optimize reimbursement and reduce denial risk. Ideal candidates are skilled at building productive relationships across departments. If you enjoy problem-solving, cross-functional collaboration, and making a measurable difference in revenue operations, this is an exciting opportunity to grow your career in a mission-driven organization. Apply today and help strengthen the financial health of our hospital system—while enjoying the flexibility of a fully remote role.

Requirements

Associate's Degree Business, Healthcare or related field Required
At least three (3) years Hospital or physician revenue cycle, billing, or coding Required
Business Skills: Knowledge of healthcare revenue cycle functions, and billing and collection processes specific to the charge master. (Required proficiency)
Regulatory: Knowledge of CMS local, state, and federal regulatory and the various data elements associated with all types of claim forms. (Required proficiency)
Business Analytics: Identifies data and analytic challenges including data integrity, appropriateness of data sample, context and consistency between sources. Fully leverages power of analytic tools (Required proficiency)
Collaboration: Experience supporting RI initiatives specific to implementation, and/or major process improvement and redesign. (Required proficiency)
Facilitator: Plans effectively yet is fluid based on the atmosphere and needs of the audience. Connects with the group. Is masterful and an engaging listener. Experience with coding, billing and CDM maintenance (Required proficiency)

Nice To Haves

Bachelor's Degree Business, Healthcare or related field Preferred
At least five (5) years Experience with coding, billing and CDM maintenance Preferred
Certified Outpatient Coder (CPC-H) - American Academy of Professional Coders (AAPC) - within 12 months - Preferred

Responsibilities

Focus on review, correction, trending and prevention of denials within Revenue Integrity’s control
Review, identify, analyze EPIC work queues, reports and claim data to identify root cause of denials
Works with the RI Specialist and their revenue producing departments to help minimize charge capture methods that may be contributing to denials by analyzing trends in payments and denials, identifying discrepancies, and collaborating with them to resolve issues, prevent revenue leakage
Perform applicable analyses to understand net revenue effect of any proposed charge capture changes.
Perform internal billing audits to ensure correcting coding/billing regulatory compliance and charge capture accuracy.
Serves as resource to Patient Financial Services staff for reporting problems and denials on individual claims. Assists in researching coding issues and recommends solution to account representative. Identifies source of problem and works with analysts to implement corrective actions to ensure that the charge capture is updated to prevent future rejections/denials and to ensure accurate and expedient reimbursement
Assist in strategic pricing process to optimize reimbursement within budget guidelines.
Participate in ongoing coordination and resolution of revenue issues as they arise.
Assists in troubleshooting and resolving issues related to the patient revenue cycle, and assists in development and recommendations.
Performs other duties as assigned.