Revenue Integrity Analyst Full Time Days

East Tennessee Children's Hospital • Knoxville, TN

2d • Onsite

About The Position

The Revenue Integrity Analyst is responsible for supporting and executing revenue integrity functions across charge capture, Charge Description Master (CDM) maintenance, coding and billing validation, reimbursement integrity, and revenue cycle performance monitoring. This role ensures the accurate, compliant, and timely translation of clinical services into revenue while proactively identifying risks, revenue leakage, and process improvement opportunities.

Requirements

• Bachelor’s degree in healthcare administration, Finance, Business, Nursing, or related field, or equivalent combination of education and experience.
• Strong working knowledge of CDM management, charge capture, and revenue cycle workflows.
• Advanced understanding of CPT, HCPCS, ICD-10 coding, NCCI edits, and reimbursement methodologies (DRG, OPPS, managed care).
• Ability to review and interpret payer contracts, billing guidelines, and regulatory requirements.
• Strong analytical, problem-solving, and audit skills with attention to detail.
• Effective written and verbal communication skills; ability to educate and collaborate with clinical and operational stakeholders.
• Proficiency in Microsoft Excel and other reporting tools; experience with Epic preferred.
• Ability to work independently, prioritize competing demands, and adapt in a small-facility, multi-hat environment.

Nice To Haves

• Experience with Epic preferred.

Responsibilities

• Maintain, review, and update the Charge Description Master (CDM), including charge codes, revenue codes, modifiers, pricing, and charge routing logic.
• Perform routine and ad hoc CDM audits to ensure accuracy, regulatory compliance, and alignment with payer and governmental requirements.
• Support annual CDM maintenance, pricing updates, and new or revised service implementations.
• Evaluate charging vehicles and workflows (clinical systems, encounter forms, and manual processes) to ensure timely and accurate charge capture.
• Partner with clinical and operational stakeholders to resolve charge capture gaps and ensure appropriate charge development.
• Monitor daily billing edits, charge errors, late charges, missing charges, and accounts not billed; research and resolve issues prior to claim submission when possible.
• Review medical records and supporting documentation to validate charges, coding accuracy, and compliance with ICD-10, CPT, HCPCS, and NCCI guidelines.
• Identify, analyze, and resolve potential or actual revenue leakage, underpayments, overpayments, and charge-related discrepancies.
• Support underpayment management and denial prevention efforts through root cause analysis and collaboration with Revenue Cycle teams.
• Escalate systemic or high-risk issues and contribute to corrective action planning.
• Conduct charge capture, coding, and documentation audits across clinical departments and service lines.
• Identify trends and recurring issues and present findings, risks, and recommendations to leadership.
• Monitor regulatory changes, payer policies, and billing rules and translate requirements into operational guidance.
• Support compliance with federal, state, and payer regulations related to charging, coding, and billing.
• Perform regularly scheduled and ad hoc updates to systems, CDM, charge processes, and related documentation as required by organizational initiatives, regulatory changes, and compliance requirements.
• Serve as a liaison to clinical departments, providers, and operational leaders for charging, coding, and revenue integrity questions.
• Provide education and guidance on proper charge capture, documentation, and billing practices.
• Support new services, procedures, and supplies by ensuring appropriate charge development and charge capture workflows are established timely.
• Collaborate with Coding, Revenue Cycle, Finance, and Managed Care to resolve issues and improve end-to-end processes.
• Monitor and report on key revenue integrity performance indicators (KPIs), including charge lag, missing charges, audit outcomes, and billing error trends.
• Prepare routine and ad hoc reports to support operational decision-making and performance improvement initiatives.
• Assist with identification, prioritization, and tracking of revenue integrity improvement opportunities.
• Assist Revenue Cycle, Coding, Finance, and Managed Care teams with special projects and operational needs.
• Handle Protected Health Information (PHI) in compliance with organizational policies and regulatory requirements

What This Job Offers

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