Revenue Integrity Specialist
About The Position
R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Revenue Integrity Analyst, you play a key role in maintaining the accuracy, compliance, and efficiency of the charge master. You are responsible for conducting in-depth audits, analyzing complex billing issues and supporting departments in ensuring accurate charge capture and reimbursement. To thrive in this role, you must have a coding background.
Requirements
- 3+ years coding experience
- Hospital coding experience
- Experience with Charge Capture Audits
Nice To Haves
- CCS, CIRCC, COC, CPC or equivalent preferred
- EPIC experience preferred
Responsibilities
- Prepares Excel analysis, including V-Lookups and pivot tables.
- Gathers and compiles data in a systematic fashion, clearly documenting assumptions, and validating accuracy of information to resolve inconsistencies.
- Evaluate and implement charge requests with appropriate CPT/HCPCS codes, revenue codes, and pricing, ensuring alignment with clinical services and coding/billing guidelines.
- Conducts Charge Capture Audits: Review and analyze patient records, billing data, and financial statements to ensure charge and coding compliance.
- Identify discrepancies or errors and develop action plan for future state resolution
- Analyzes data to identify likely relationships, summarizes data and prepares summary materials for discussion with clinical and finance teams.
- Monitor regulatory changes and payer updates that may impact charge master and revenue integrity.
- Collaborates with various departments to resolve CDM or RI discrepancies (Utilization Management (UM), Clinical Documentation Integrity (CDI), RCM, Coding Services, Clinical Departments, and Health Information Management (HIM)).
- Serve as a liaison during system upgrades, new service implementation, and pricing reviews.
- Maintain and update the Charge Description Master (CDM)
- Sox Control regulations
- Ensure charges comply with: CMS (Medicare OPPS/IPPS) rules, NCCI edits, Local Coverage Determinations (LCDs) / NCDs, Payer-specific billing requirements
- Validate correct assignment of: HCPCS/CPT codes, Modifiers, Units of service
- Monitor annual/quarterly code updates (e.g., CPT, HCPCS, APC changes)
- Review clinical workflows to ensure all billable services/supplies are captured
- Identify missed revenue opportunities (undercharges, missing charges)
- Partner with departments (Radiology, OR, Cath Lab, etc.) to validate charge practices
- Analyze denials tied to: Incorrect HCPCS/CPT, Missing modifiers, Bundling/edit issues
- Recommend CDM or workflow fixes to prevent recurrence
- Investigate and resolve: Charge errors, Denials related to coding or CDM setup
Benefits
- annual bonus plan at a target of 5.00%
- competitive benefits package
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
