The Revenue Integrity Analyst plays a vital role in ensuring ethical, accurate, and compliant revenue capture throughout the organization. This position is responsible for auditing charge capture, posting infusion and injection charges, preparing Good Faith Estimates (GFEs), conducting insurance claim audits, and working with departments across the organization to maintain revenue integrity throughout the revenue cycle.
The role requires strong attention to detail, analytical thinking, and comprehensive knowledge of coding and billing regulations. The analyst collaborates with front-end, mid-cycle, and back-end revenue functions, supports charge review and validation, assists with system charge mapping, and helps identify and resolve discrepancies through audit findings and root cause analysis.
Additional responsibilities include responding to staff questions about coding, charging, modifier use, and related projects; supporting timely and accurate claims processing; and helping educate departments to prevent recurring issues.
• Associate's degree preferred. • One of the following certifications is required: RHIT, CCS, COC, or CPC. • Candidates actively pursuing a credential must obtain it within six months of hire. • Certification must be maintained after hire. • Strong understanding of medical terminology, human anatomy, CPT/HCPCS codes, NCCI edits, and coverage determinations (LCD/NCD). • Familiarity with provider-based billing, critical access hospital regulations, and Medicare claims processing guidelines. • Knowledge of CMS regulations, third-party payer rules, and official coding guidelines (AHA and AMA).
Location
Ohio, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago