Senior Revenue Integrity Analyst

Luminis Health • Annapolis, MD

6d • $95,000 - $118,000 • Onsite

About The Position

The Senior Revenue Integrity Analyst works in the Luminis Health Revenue Integrity department and serves as the key liaison and subject matter expert on all aspects of hospital charge capture and entry, charge integrity, and charge reconciliation processes. This position leads complex revenue integrity initiatives across multiple departments, serves as the primary subject matter expert for charge capture and CDM optimization, and provides strategic recommendations to leadership to improve revenue capture, regulatory compliance, and reimbursement outcomes. They will align with clinical leadership and serve as the subject matter expert regarding billing compliance, accuracy of charge capture and integrity processes including education, audit activities, changes, or risk of revenue (regulatory or coding changes) and monitoring of charge capture related metrics to minimize revenue leakage.

Requirements

• BS in Finance, Accounting or Healthcare related field preferred
• In lieu of BS degree, 10 years of hospital Revenue Cycle/Revenue Integrity experience preferred
• 5-7 years’ experience supporting Revenue Cycle and Clinical systems
• Works well in environment with firm deadlines; results oriented
• Demonstrates strong knowledge of end-to-end revenue cycle
• Experience in EPIC required
• Experience with Microsoft Office, Word, and Excel
• Ability to communicate professionally via internet and virtual communication tools
• Coding certification (CPMA, CPC, CBCS, CCS, or equivalent) required. Candidates without certification must obtain an approved certification within 18 months of hire.

Responsibilities

• Manages and tracks all hospital 3rd party payer audits; performs defense audits and educates clinical departments on lost payment opportunities
• Performs internal review of Revenue Cycle processes
• Collects, disseminates, and educates clinical departments on all state and federal billing/coding/charging updates
• Provides charge capture education to clinical departments
• Performs CDM audits in accordance with Luminis Health Chargemaster Review Policy
• Proficient Use of Support Systems
• Efficient utilization of billing system database to update, Charge Description Master (CDM); ensures broad understanding of all areas of revenue cycle including pre-AR, actualized AR review, and router logic
• Ability to appropriately edit charges via Charge Router and document actions via notes in the Resolute billing system.
• Demonstrated ability to utilize Outlook email and navigate in the Word and Excel software applications.
• Competence in Coding, Billing and Charge Integrity Workflows
• Evaluates current charging and coding structures in clinical, coding and Revenue Cycle departments to ensure appropriate capture and reporting of revenue and compliance with state/federal government and third-party payer requirements
• Assess the accuracy and build of all Charge Capture related workflows in EPIC, including documentation, automation enhancements
• Demonstrates the ability to understand and utilize payer rejections and remittance denials to execute denial management strategies to mitigate the risk of future denials
• Serves as the primary escalation point for complex revenue integrity, charge capture, coding, billing, and compliance issues and provides expert guidance to operational and clinical stakeholders
• Leads and manages strategic revenue integrity projects and department initiatives designed to improve revenue capture, enhance operational effectiveness, reduce denials, and ensure regulatory compliance
• Provides mentorship, guidance, and subject matter expertise to Revenue Integrity Analysts and other revenue cycle professionals; supports skill development and knowledge sharing across the department
• Influences operational and leadership decision-making through analysis of revenue integrity trends, audit findings, regulatory requirements, payer activity, and process improvement opportunities
• Collaborates with Revenue Integrity leadership to develop, implement, maintain, and continuously improve departmental policies, procedures, standards, and best practices
• Effectively maintains audit and account activity by ensuring the proper organization, tracking, filing, and documenting of all correspondence
• Assists in proactive communication and root cause analysis of challenges impacting final adjudication of claims, including but not limited to system or payer issues
• Creates a cross-collaborative approach with Billing teams, Coding, HIM, and other key stakeholders to improve charge capture, compliant documentation to substantiate charges, charge reconciliation, and compliant billing of all charges

Benefits

• Medical, Dental, and Vision Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Employee Assistance Programs

What This Job Offers

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