Revenue Integrity Analyst

Berkshire Health Systems • Pittsfield, MA

1d

About The Position

The Revenue Integrity Analyst identifies, analyzes, and resolves reimbursement variances to help ensure Berkshire Health Systems receives accurate payment under payer contracts, fee schedules, and applicable regulatory requirements. The role uses reimbursement analytics tools to compare expected and actual payments, identify payer underpayments, investigate discrepancies, support appeals and recovery efforts, and monitor payer compliance with contractual reimbursement terms.

Working collaboratively with Revenue Cycle, Patient Financial Services, Payor Contracting, Information Technology, and operational leaders, the analyst evaluates reimbursement trends, determines the root causes of payment variances, assists with contract modeling and system validation, and recommends process improvements to strengthen payment accuracy and net revenue. Knowledge of Medicare, Medicaid, and commercial payer reimbursement methodologies, hospital billing practices, and contract interpretation is important. Charge capture, coding, documentation, and denial analysis may be performed as needed to support reimbursement investigations and payment recovery.

Requirements

• Three years of experience in healthcare reimbursement, revenue cycle, contract management, payment integrity, or a related analyst role.
• Knowledge of inpatient and outpatient hospital reimbursement, payer contracts, payment methodologies, and Medicare, Medicaid, and commercial reimbursement practices.
• Strong quantitative, analytical, and organizational skills.
• Bachelor of Arts degree in Business Administration, Finance, Accounting, or a closely related field.
• Strong computer skills.
• Exceptional written and verbal communication and interpersonal relationship skills.
• Advanced experience with Microsoft Office, especially Excel, Word, and Outlook.
• Ability to establish and maintain effective relationships.
• Ability to handle stressful situations calmly and rationally and work under deadline pressures.
• Willingness to accept additional responsibilities and duties as required by the position.
• Self-motivated, able to work autonomously, and skilled in problem solving.
• Demonstrated commitment to continuous improvement.
• Experience working in a team-oriented, collaborative environment.

Nice To Haves

• Experience with contract management or reimbursement analytics systems.
• Experience with Expanse and/or Meditech software.

Responsibilities

• Identify, analyze, and resolve reimbursement variances.
• Compare expected and actual payments using reimbursement analytics tools.
• Identify payer underpayments and investigate payment discrepancies.
• Support appeals and payment recovery efforts.
• Monitor payer compliance with contractual reimbursement terms.
• Evaluate reimbursement trends and determine root causes of payment variances.
• Assist with contract modeling and system validation.
• Recommend process improvements to strengthen payment accuracy and net revenue.
• Perform charge capture, coding, documentation, and denial analysis as needed to support reimbursement investigations and payment recovery.
• Collaborate with Revenue Cycle, Patient Financial Services, Payor Contracting, Information Technology, and operational leaders.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level