The Wilshire Group is seeking three experienced Revenue Integrity Service Line Analysts to support revenue integrity initiatives in a fully remote consulting environment.
This role partners with physicians, clinical teams, operations, finance, compliance, coding, patient access, HIM, IT, and revenue cycle stakeholders to improve accurate and compliant revenue capture. The analyst will review end-to-end workflows, identify revenue opportunities, and help implement practical, sustainable improvements.
Key responsibilities
- Serve as a revenue integrity resource for assigned clinical service lines.
- Review the relationship between the chargemaster (CDM), clinical workflows, Epic configuration, charge capture logic, and downstream billing processes.
- Maintain Epic chargemaster content within assigned areas.
- Perform end-to-end assessments of scheduling, documentation, charge capture, billing, reimbursement, and payment workflows.
- Identify root causes of missed, inaccurate, or incomplete charges and recommend corrective actions.
- Work with business and technical teams to improve workflows, system configuration, documentation, and charge capture processes.
- Analyze operational, financial, and utilization data to identify trends, charging variances, underpayments, missed revenue, and revenue optimization opportunities.
- Monitor implemented changes and measure results.
- Support or lead revenue integrity assessments for new clinical programs, technologies, procedures, and service lines.
- Maintain knowledge of federal and state regulations, payer requirements, CPT, HCPCS, ICD-10-CM/PCS, NCCI, Medicare guidance, and revenue cycle best practices.
- Provide guidance to other analysts as needed.
Requirements & Qualifications
Required qualifications and skills
- Advanced knowledge of hospital and professional revenue cycle operations, including revenue integrity, charge capture, coding, billing, and reimbursement.
- Strong Epic revenue cycle experience, including chargemaster/CDM management, charge router functionality, charging workflows, and workflow optimization.
- Ability to evaluate clinical and revenue cycle workflows across multiple service lines and turn findings into practical recommendations.
- Strong analytical, critical-thinking, and problem-solving skills.
- Ability to independently manage priorities and work effectively with cross-functional teams in a remote environment.
- Strong communication and relationship-building skills.
- Bachelor's degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or a related field, or an equivalent combination of education and experience.
- Progressive revenue integrity experience, including service line assessments, revenue optimization, and cross-functional initiatives.
- Epic Revenue Integrity/Chargemaster certification or demonstrated Epic Revenue Cycle experience preferred.
- Revenue integrity, coding, or revenue cycle certification preferred, such as CPC, COC, CCS, CHRI, CRCR, or equivalent.
- Clinical experience or clinical education/credentials, such as RN or another relevant clinical background, is a plus for senior-level candidates.
Location
Boston, Massachusetts, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
1 month ago