Revenue Integrity Analyst

Saint Peters Healthcare System

4d•$90,771 - $149,739

About The Position

The Revenue Integrity Analyst is responsible for the accuracy and integrity of the Epic charge description master (CDM), including charge codes, descriptions, CPT/HCPCS assignments, revenue codes, modifiers, units of service, and effective dating. The role maintains fee schedule groups, pricing records, charge routing rules, charge triggers, and order-entry linkage, ensuring price changes are applied to the correct entities. The analyst identifies missing charges through late charge analysis, revenue and usage variance review, and department reconciliation exception reporting. They analyze reimbursement variances related to charges or the CDM, monitor high-risk charging areas on a defined cadence, and conduct routine charge audits to verify that services are documented, charged, coded, billed, and reimbursed correctly and consistently. Additional audits may be requested. The position develops and delivers role-based charge capture and reconciliation training and serves as a first-line consultant to clinical departments on building, charging, and reconciling new services, orders, supplies, and drugs. The analyst leads the annual pricing update process with Finance and Managed Care, including modeling price-change impact by payer, service line, and volume. They also serve as operational lead to the Financial Integrity Committee, coordinate build decisions among involved parties, and maintain a centralized log of CDM requests.

Requirements

Bachelor's degree in health information management, healthcare administration, finance, business, nursing, or a related field; equivalent directly relevant experience may be substituted.
At least five years of hospital revenue cycle experience with direct chargemaster, revenue integrity, or hospital billing responsibility.
Working knowledge of CPT, HCPCS, revenue codes, modifiers, UB-04 claim structure, NCCI and MUE edits, and OPPS/APC methodology.
Ability to analyze charge, revenue, and reimbursement data and communicate findings to clinical and financial audiences.
Experience training or advising non-financial clinical staff on charge capture.
Strong Excel skills and ability to work with large charge and claim data extracts.

Responsibilities

Own and maintain the accuracy and integrity of the Epic charge description master, including charge codes, descriptions, CPT/HCPCS assignments, revenue codes, modifiers, units of service, and effective dating.
Maintain fee schedule groups and pricing records, ensuring price changes are applied to the correct entities.
Maintain charge routing rules, charge triggers, and order-entry linkage.
Identify and pursue missing charges through late charge analysis, revenue and usage variance review, and department reconciliation exception reporting.
Analyze reimbursement variances when the root cause is charge- or CDM-related.
Monitor high-risk charging areas on a defined cadence, including high-dollar areas.
Develop and deliver role-based charge capture and reconciliation training for end-users.
Advise clinical departments on how new services, orders, supplies, and drugs should be built, charged, and reconciled.
Perform routine charge audits to validate that services are documented, charged, coded, billed, and reimbursed correctly and consistently.
Perform additional audits as requested.
Lead the annual pricing update process in partnership with Finance and Managed Care, including modeling price-change impact by payer, service line, and volume.
Serve as operational lead to the Financial Integrity Committee and coordinate build decisions among all parties.
Maintain a centralized log of CDM requests.