The Revenue Integrity Analyst ensures accurate and compliant patient billing by analyzing charge capture, coding, and claims processes, identifying revenue leakage through audits and data analysis, and implementing improvements via education and system updates, working with clinical and financial teams to optimize reimbursement and maintain payer compliance. Coordinates and implements projects and personnel-related activities. Works under the guidance of the Supervisor. Interacts with medical staff, provider offices, nursing, ancillary departments, and outside organizations.

Responsibilities include:

Assisting with validating annual pricing updates to the Charge Description Master (CDM) to ensure accuracy and optimize reimbursement within budget.
Collaborating across departments such as clinical, IT, billing, and coding to resolve issues and implement solutions.
Staying updated on payer regulations (Medicare, commercial), educating staff, and ensuring adherence to guidelines.
Conducting audits, analyzing claim data, reviewing charge capture, and investigating variances.
Developing and monitoring KPIs to identify new initiatives, track improvements, and document performance.
Creating standardized charge capture processes including daily reconciliation and reporting.
Performing root cause analysis of charge capture, audits, and CDM to resolve denials and billing edits.
Developing and implementing corrective actions, improving workflows, and enhancing CDM integrity.
Creating reports, tracking trends, and presenting findings to leadership to drive financial performance.
Supporting denial prevention activities and strategic Revenue Cycle planning to ensure compliance with Federal and State regulations, payer policies, and coding guidelines.