Senior Revenue Integrity Analyst
About The Position
The Senior Revenue Integrity Analyst provides subject matter expertise in charge capture, CDM application, compliance, and reimbursement. The role leads audits, supports governance, and drives revenue optimization initiatives across clinical departments while ensuring alignment with CMS and payer requirements. The analyst monitors charge capture accuracy, identifies workflow issues and revenue risks, supports CDM updates, and conducts audits to validate charge mappings and billing rules. The role analyzes trends and financial impacts, develops corrective action plans, supports regulatory compliance and annual CPT/HCPCS updates, and collaborates with clinical, operational, and leadership teams to improve processes. It also includes developing reports and dashboards and providing data-driven recommendations.
Requirements
- Bachelor's degree; relevant certifications and demonstrated work experience may be substituted for the required degree.
- At least 5 years of hospital revenue cycle, charge capture, or CDM experience.
- Advanced knowledge of CPT/HCPCS and reimbursement.
- Expertise in CDM structure and clinical application.
- Strong auditing and compliance background.
- Ability to analyze the financial impact of charge issues.
- Experience with workflow redesign and optimization.
- Advanced Excel and data analysis skills.
- Ability to lead training and education initiatives.
- Strong communication across clinical and executive teams.
- Knowledge of CMS, Medicaid, and payer rules.
- Experience with dashboards and reporting.
Nice To Haves
- CPC, CCS, RHIT/RHIA, or Epic certification.
Responsibilities
- Monitor departmental charge capture accuracy through analysis of work queues and reconciliation reports.
- Identify charge capture gaps, workflow issues, and systemic revenue loss risks.
- Provide guidance, training, and education to clinical departments.
- Partner with the CDM team on updates and recommend improvements.
- Conduct pre- and post-bill audits to validate charge mappings and billing rules.
- Analyze trends and root causes affecting reimbursement, compliance, and financial performance.
- Quantify revenue at risk, assess the financial impact of charge issues, and develop corrective action plans to optimize revenue initiatives.
- Ensure CMS and regulatory compliance.
- Support annual CPT/HCPCS updates.
- Collaborate with Coding, IT, Finance, Compliance, and leadership to resolve issues and improve processes.
- Support governance committees.
- Develop reports and dashboards and deliver data-driven recommendations to leadership.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
