SENIOR REVENUE INTEGRITY ANALYST FT

PSN Services LLC•Plano, TX

About The Position

The Senior Revenue Integrity Analyst is a high-impact individual contributor responsible for ensuring the completeness and accuracy of revenue across Legent Health’s surgical hospitals and ambulatory surgery centers. This role spans the entire revenue cycle—from pre-operative charge capture validation through payment variance resolution—and serves as the analytical bridge between revenue cycle operations and the revenue accountant. The Senior Analyst identifies systemic revenue leakage, validates expected reimbursement against payer contracts and fee schedules, investigates underpayments and overpayments, and drives cross-functional process improvements that produce measurable financial results. This is not an accounting role; it is an operationally focused position that ensures every dollar earned in the operating room is accurately captured, correctly billed, properly reimbursed, and reliably reconciled.

Requirements

Bachelor’s degree in health administration, health information management, finance, business, or a related field.
Minimum 3–5 years of progressive experience in healthcare revenue cycle operations, with direct involvement in at least two of the following: charge capture, chargemaster management, coding, revenue integrity, contract underpayment analysis, or payment variance resolution.
Demonstrated experience in a hospital or ASC setting, preferably surgical.
Strong working knowledge of CPT, HCPCS, ICD-10-CM/PCS, revenue codes, NCCI edits, and Medicare reimbursement methodologies (DRG, APC, ASC groupers).
Proficiency in at least one major hospital EHR/practice management system.
Advanced Excel skills (pivot tables, VLOOKUP/INDEX-MATCH, data modeling) and experience with data visualization tools (Power BI, Tableau, or equivalent).
Ability to work cross-functionally with clinical, operational, and financial stakeholders without positional authority.
Strong analytical and problem-solving skills, with the ability to move from data to root cause to systemic fix.
Experience in a multi-facility or PE-backed healthcare platform environment.
Direct experience with surgical billing for high-acuity specialties (spine, orthopedic, cardiac, bariatric), including implant charge processes and bill-only workflows.
Familiarity with contract management and payer modeling tools.
SQL or equivalent query capability for ad hoc data analysis.
Experience evaluating or managing AI/automation tools within revenue cycle operations.

Nice To Haves

CHRI (Certification in Healthcare Revenue Integrity) – NAHRI, (preferred)
CRIP (Certified Revenue Integrity Professional) – AAHAM, (preferred)
CPC (Certified Professional Coder) – AAPC or CCS (Certified Coding Specialist) – AHIMA, (preferred)
CRCR (Certified Revenue Cycle Representative) – HFMA, (preferred)

Responsibilities

Perform daily charge-to-schedule reconciliation across all surgical facilities, comparing the operative schedule against posted charges to identify missing or incomplete items.
Own the chargemaster (CDM) for accuracy and compliance, including adding, modifying, and deactivating charge codes, validating CPT/HCPCS and revenue code assignments, and coordinating annual pricing updates aligned with budgetary and managed care contract requirements.
Reconcile implant, device, and supply charges against operative reports, vendor invoices, and physician preference cards for high-acuity surgical specialties (spine, orthopedic, cardiac, bariatric).
Audit charge capture completeness for both hard-coded and soft-coded items, with particular focus on commonly missed add-on codes, bilateral modifiers, and segmental instrumentation charges.
Partner with OR staff, materials management, and surgical services leadership to close documentation and charge capture gaps at the point of service.
Model expected reimbursement at the CPT and line-item level using payer calculators and the contract management tool, comparing expected versus actual allowed amounts for each case.
Monitor payer-specific rules, bundling logic, and implant authorization thresholds to proactively flag claims at risk of underpayment or denial before submission.
Produce payer performance scorecards identifying contracts that are systematically underpaying, overpaying, or deviating from contractual terms, and support the managed care team with data for renegotiations.
Validate that contractual adjustments, write-offs, and allowances are calculated correctly and consistently across all facilities.
Analyze payment variances—both underpayments and overpayments—against expected reimbursement, quantifying impact by payer, service line, facility, and procedure type.
Investigate denial root causes by payer and category, track trends over time, and drive corrective action upstream to prevent recurrence.
Work closely with the revenue accountant to reconcile recorded revenue against expected and actual payments, ensuring the integrity and accuracy of financial reporting.
Monitor AR aging, late charges, DNFB, and days-to-bill metrics, escalating anomalies and providing root cause analysis.
Identify and quantify revenue at risk from payer audit activity, retroactive payment adjustments, and post-payment recoveries.
Identify root causes of revenue leakage—broken charge routing rules, outdated CDM items, missing preference card updates, training gaps—and implement permanent, systemic fixes.
Build and maintain repeatable revenue integrity playbooks that can be deployed across new facility acquisitions and integrations.
Collaborate cross-functionally with verification of benefits and authorization teams, coding, billing, clinical documentation, and facility operations to resolve issues and standardize processes.
Develop and present dashboards, KPI reports, and executive-level summaries for revenue cycle leadership and governance committees.
Evaluate and support the implementation of AI-powered and automation tools for charge capture, predictive denial prevention, and contract compliance, serving as the subject matter expert who validates tool performance.
Lead or participate in revenue integrity governance meetings, providing data-driven recommendations that connect operational improvements to EBITDA impact.