Surgical Services Revenue Integrity Analyst (Charge Capture and CPT Specialist)

Cayuga Health System•City of Ithaca, NY

1d•Hybrid

About The Position

The Surgical Services Revenue Integrity Analyst is responsible for ensuring accurate, complete, and compliant charge capture and CPT code assignment across all perioperative and procedural areas. This role applies advanced knowledge of clinical documentation, coding guidelines, and revenue cycle processes to validate that services rendered are appropriately captured and billed. Serving as a key liaison between Surgical Services, Revenue Integrity, HIM Coding, and Finance, this position performs detailed audits of clinical and billing data, identifies revenue leakage, and drives process improvements to optimize reimbursement while maintaining regulatory compliance.

Requirements

Bachelor's degree in Health Information Management, Nursing, Healthcare Administration, or related field required
3-5 years of experience in healthcare revenue cycle, surgical services, coding, or charge capture
Experience with EMR systems (Epic preferred)
Advanced understanding of CPT/HCPCS coding and procedural billing practices
Knowledge of ICD-10 and healthcare reimbursement systems
Strong analytical and auditing skillset
Ability to manage audits and prioritize workload
Strong communication and collaboration skills
High attention to detail and compliance focus

Nice To Haves

Master's degree preferred
Experience in perioperative services strongly preferred
CPC, CCS, RHIT, or RHIA preferred or required within defined timeframe
CNOR preferred

Responsibilities

Conduct routine and ad hoc audits of surgical and procedural cases to ensure all billable services, supplies, implants, and medications are accurately captured.
Validate that clinical documentation supports charges, CPT code selection, and level of service.
Reconcile discrepancies between clinical documentation, preference cards, and charges within the EMR (e.g., Epic).
Partner with Revenue Integrity and Coding teams to develop, validate, and maintain CPT code mappings for surgical and procedural services.
Review new procedures, equipment, and service line expansions to ensure appropriate CPT assignment and charge structure.
Ensure alignment between procedure scheduling, CPT coding, and actual case performance.
Adhere to CPT, HCPCS, ICD-10, and regulatory billing guidelines.
Support denial management efforts by identifying root causes related to coding inaccuracies or documentation gaps.
Participate in internal and external audits.
Analyze trends in charge capture accuracy, missed charges, and coding discrepancies.
Develop audit criteria and reporting tools to monitor performance.
Utilize EMR reporting tools and billing platforms to validate accuracy.
Evaluate workflows related to charge entry, documentation, and billing.
Implement standardized processes across procedural areas.
Educate physicians, nurses, and surgical staff on documentation and charge capture expectations.
Serve as a subject matter expert for coding and billing questions.