Senior Revenue Integrity Analyst

Job Summary: The Senior Revenue Integrity Analyst serves as a subject-matter expert in charge capture, charge workflow optimization, revenue reconciliation, and the evaluation of new or enhanced services. This role leads complex investigations into revenue leakage, develops and implements corrective action plans, and supports enterprise-wide process improvements. The Senior Analyst partners closely with clinical operations, coding, finance, Information Technology (IT), and revenue cycle leadership to ensure accurate charging practices within Epic.

Minimum Education: High school diploma or GED. Bachelor’s degree in Business, Finance, Healthcare Administration, or related field, preferred.

Licensure, Registration and/or Certification: None. Certified Revenue Cycle Representative (CRCR) from the Healthcare Financial Management Association (HFMA), preferred. Epic Certifications (Resolute Hospital Billing, Resolute Professional Billing, Revenue Integrity), preferred.

Work Experience: Minimum 5 years of Billing, Charge Capture, Charge Description Master (CDM) Management, Revenue Cycle Analytics, or Revenue Integrity within Healthcare experience.

Knowledge, Skills, and Abilities: Advanced knowledge of charge capture processes, charge router logic, charging methodologies, and clinical workflows. Advanced knowledge of healthcare coding systems (Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding Systems (HCPCS), International Classification of Diseases (ICD-10)), and reimbursement methodologies. Strong understanding of Epic workflows, including charge router, charge review, work queues, and Charge Description Master (CDM) integration. Strong data analysis capabilities, including with large datasets, financial modeling, and root-cause analysis. Knowledge of healthcare regulatory requirements and revenue cycle operations. Strong leadership and collaboration skills. Excellent communication skills, both written and verbal that present clear and concise information. Effective organizational skills and attention to detail. Ability to educate and mentor staff, influence decision-makers, and communicate technical concepts to non-technical audiences. Ability to independently manage complex projects, timelines, and cross-functional deliverables.

Essential Functions and Responsibilities: Leads efforts to ensure accurate, complete, and comprehensive charge (revenue) reconciliation is performed by charge generating departments. Reviews proactively Epic charging logic, including charge triggers, routing rules, and work queue management. Conducts advanced analytics to identify financial variances, operational gaps, and revenue risk. Partners with coding, clinical leadership, finance, and IT to design and implement improvements to charge capture and billing processes. Designs and leads development of complex reports, dashboards, and analyses. Provides training, mentorship, and guidance to Revenue Integrity Analysts and department staff. Leads or co-lead enterprise initiatives related to charge workflows, revenue integrity, regulatory readiness, or service-line reviews. Identifies and escalates systemic compliance or reimbursement risks to leadership.

Decision Making: Independent judgment in making decisions involving non-routine problems under general supervision.

Working Relationships: Coordinates activities of others (does not supervise). Coordinates and leads others in same work performed (does not supervise). Works directly with patients and/or customers. Works with internal and/or external customers via telephone or face to face interaction.

Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

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