Revenue Integrity Analyst
Care New England
full-time
Posted on:
Location Type: Office
Location: Warwick • Rhode Island • United States
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About the role
- Conduct in-depth analysis of Epic Revenue Guardian reports, charge work queues, and other data sources to identify systemic charge capture issues, trends, and patterns.
- Reconcile clinical documentation against charges, with emphasis on identifying root causes of discrepancies and developing process improvements.
- Partner with Revenue Integrity leadership to monitor key performance indicators (KPIs), prepare dashboards, and present findings to management and clinical leaders.
- Collaborate with all revenue cycle teams to recommend workflow changes that improve documentation accuracy, charge capture, and reimbursement.
- Contribute to ongoing review and optimization of CDM and charge workflows, ensuring alignment with regulatory and payer guidelines.
- Assist in the development of Revenue Guardian rules, edits, and reports to improve monitoring and charge capture.
- Prepare detailed audit support documentation and partner with revenue cycle leaders on internal and external audit responses.
- Identify and escalate systemic revenue leakage issues, recommending strategies for resolution.
- Support development of training materials and provide guidance to clinical and operational teams on charge capture best practices.
- Stay current on regulatory changes, payer policies, and industry best practices, and assess their impact on charge capture workflows.
- Serve as a subject matter expert for charge integrity initiatives, providing insights and recommendations to leadership.
- Demonstrate accountability and initiative in advancing organizational goals around revenue optimization, and efficiency.
Requirements
- High School or GED Required; Associate's Degree Preferred.
- Minimum 3 to 5 Years experience
- Knowledge of CPT, HCPCS, and ICD-10 coding systems and their application to charge capture and reimbursement.
- Strong understanding of healthcare revenue cycle operations, including facility and professional billing workflows.
- Familiarity with Medicare, Medicaid, and commercial payer reimbursement methodologies and requirements.
- Proficiency with Epic (or comparable EHR/EMR systems), with the ability to analyze work queue data, configure Revenue Guardian rules, and develop reports.
- Working knowledge of the Charge Description Master (CDM) and its impact on pricing, charging, and reimbursement.
- Demonstrated analytical skills with the ability to extract, interpret, and present complex data sets using Excel and other reporting tools.
Benefits
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