Revenue Integrity Analyst

Ventura County • Ventura, CA

2d • Onsite

About The Position

The Revenue Integrity Analyst plays a critical role in supporting the financial health and regulatory compliance of Ventura County Medical Center, Santa Paula Hospital, and affiliated ambulatory clinics. Under the general direction of the Revenue Integrity Manager, the incumbent performs advanced analytical, consultative, and project leadership work to support the County's Revenue Integrity Program. This position serves as a subject matter resource for Chargemaster (CDM) governance, charge capture, reimbursement, coding, billing, regulatory compliance, and revenue cycle improvement initiatives. The Revenue Integrity Analyst exercises a high degree of independent judgment while partnering with clinical departments as well as Finance, Patient Financial Services, Compliance, Health Information Management, Informatics, Pharmacy, and executive leadership to evaluate operational processes, optimize reimbursement, promote regulatory compliance, and reduce organizational financial risk. The position also supports the implementation of new clinical services, operational initiatives, and system enhancements that improve revenue cycle performance across the health system. The ideal candidate is a collaborative healthcare revenue cycle professional with strong analytical abilities and experience interpreting complex reimbursement and regulatory requirements. They possess a solid understanding of healthcare coding, billing, charge capture, and reimbursement methodologies and are skilled at translating technical requirements into practical operational solutions. The successful candidate is comfortable working with multidisciplinary teams, managing multiple priorities, developing data-driven recommendations, and communicating effectively with physicians, operational leaders, and executive leadership. Experience supporting Revenue Integrity initiatives, Chargemaster (CDM) management, reimbursement analysis, healthcare process improvement, and regulatory compliance is highly desirable.

Requirements

• A bachelor's degree in healthcare administration, business administration, public administration or a related field, AND one (1) year of experience in revenue integrity, hospital professional coding/billing experience, or revenue optimization.
• Candidates must possess and maintain a current coding certification from a nationally recognized organization. Acceptable certifications include: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Associate (CCA), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC), Or other nationally recognized equivalent coding certification.
• Intermediate proficiency in Microsoft Excel, using formulas, PivotTables and data validation.

Nice To Haves

• Revenue integrity certification (such as CRIP or CHRI).
• Related work experience may substitute the educational requirement on a year for year basis.

Responsibilities

• Coordinates complex Revenue Integrity initiatives under the direction of the Revenue Integrity Manager.
• Serves as the operational lead for Chargemaster (CDM) governance, including maintenance, pricing recommendations, revenue code assignments, regulatory updates, and implementation of new services.
• Evaluates charging, coding, billing, and reimbursement requirements for new clinical services, procedures, and operational initiatives.
• Researches, interprets, and applies Medicare, Medi-Cal, commercial payer, and regulatory billing requirements and recommends operational improvements.
• Performs revenue integrity reviews, reimbursement analyses, charge capture assessments, coding validations, and operational audits to identify revenue opportunities and compliance risks.
• Analyzes reimbursement trends, denials, payment variances, and operational data to identify root causes and recommend corrective actions.
• Collaborates with Informatics regarding electronic health record (EHR) configuration, charging workflows, clinical documentation, and system enhancements affecting reimbursement.
• Partners with clinical departments and Finance, Patient Financial Services, Compliance, Pharmacy, and Health Information Management to resolve complex charging, coding, billing, and reimbursement issues.
• Develops policies, procedures, workflow recommendations, and educational materials related to revenue integrity, coding, charging, reimbursement, and regulatory compliance.
• Provides technical consultation and education to physicians, department leadership, and operational staff regarding reimbursement, charge capture, coding, and documentation requirements.
• Develops reports, dashboards, and presentations utilizing Microsoft Excel and other reporting tools to support operational and executive decision-making.
• Participates in multidisciplinary committees, strategic initiatives, and special projects supporting revenue cycle optimization and organizational goals.
• Prepares reports and presents findings and recommendations to the Revenue Integrity Manager and executive leadership.
• Performs other related duties as assigned.

Benefits

• Possible educational incentive of 2.5%, 3.5%, or 5% based on completion of Associate's, Bachelor's, or Master's degree.
• Eligible for bilingual incentive depending upon operational need and certification of skill.
• Eligible for benefits at the MB3 level.

What This Job Offers

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