Revenue Integrity Analyst

Working under the direction of an IRI Principal, the Revenue Integrity Analyst will support client engagements focused on optimizing charge capture, coding accuracy, regulatory compliance, and revenue performance across hospital and provider organizations. This role requires a keen eye for detail, strong analytical skills, and a deep understanding of healthcare billing and reimbursement regulations.

Tasks may include, but are not limited to:

·         Charge Capture Validation: Perform revenue integrity audits including verifying the accuracy and completeness of charge capture to ensure all billable services are appropriately documented and charged.

·         Coding Review: Review medical records, claims, and billing data to ensure accurate coding practices according to industry standards (e.g., ICD-10-CM, CPT, HCPCS, etc.) and compliance regulations.

·         Denial Management: Investigate and resolve claim denials by identifying root causes, suggesting possible corrective action improvements.

·         Documentation Improvement: collaborate with clients to improve documentation accuracy and completeness which directly impact coding accuracy and revenue capture.

·         Billing: Analyzing and resolving NCCI billing edits and denials or client work queues

·         Reviewing charge builds in the Charge Description Master (CDM) to determine appropriateness of coding assignments.

·         Reviewing regulatory and compliance updates

·         Answering client questions related to billing, coding, reimbursement, compliance, and related topics.

·         Maintaining ongoing education and training via webinars, seminars, courses, and other on-the-job training as needed

COMPETENCIES

·         Requires critical thinking skills, decisive judgement, and the ability to work with minimal supervision in a remote environment.

·         Ability to multi-task and meet deadlines with effective time management skills.

·         Maintains high performance standards and personal integrity of job performance.

·         Strong interpersonal verbal and written communication skills, effectively presenting information to management, groups, and individuals.

MINIMUM QUALIFICATIONS AND EDUCATION REQUIREMENTS

·         5 years of experience in hospital revenue cycle (billing/reimbursement/coding/auditing)

·         1+ years of coding experience and certification (e.g., CPC, COC, CCS)

·         Knowledge of guidelines related to CPT/HCPCS codes, revenue codes, modifiers, NCCI edits, chargeable services, etc.

·         Experience with hospital EHR systems (e.g., EPIC, Meditech, Cerner, CPSI)

·         Working knowledge of payer policies and claim billing

·         Strong understanding of healthcare regulatory requirements such as CMS, HIPAA, Stark Law, and Anti-kickback Statutes

·         Effective communication and interpersonal skills to collaborate with diverse stakeholders

·         Experience with Microsoft applications including Word, Excel, and PowerPoint

PREFERRED QUALIFICATIONS

·         Bachelor’s degree in Healthcare Management, Business, or Finance

·         7-10 years of experience in hospital revenue cycle

·         Prior experience as a Revenue Integrity Analyst