Revenue Integrity Analyst / Senior Analyst
We are seeking a few highly skilled and detail-oriented Revenue Integrity Analyst(s) / Senior Analysts to join our consulting team with a possible permanent position at our client. This role is essential in ensuring the integrity of revenue processes by focusing on charge capture, clinical documentation management, compliance, and denial prevention, and reducing revenue leakage. The ideal candidate will play a critical role in safeguarding operational efficiency, improving reimbursement, and supporting organizational goals through their expertise in claims analysis, coding audits, and charge master processes.
Key Metrics of Success :
- Reduction in denial rates through improved claims management and appeal processes.
- Minimization of revenue leakage through accurate charge capture and coding audits.
- Enhanced clinical documentation that aligns with coding and billing requirements.
Proactive Qualifications :
Strong knowledge of healthcare revenue cycle, coding standards (e.g., ICD-10, CPT, and HCPCS), and billing regulations.Exposure / experience with Epic, Cerner, etc.Experience with charge description master management, claims denial analytics, and workflows associated with clinical charge capture.Familiarity with payer guidelines and regulatory compliance in revenue cycles.Responsibilities :
Revenue Integrity Oversight : Perform daily activities to uphold and enhance the organization's revenue integrity processes, ensuring accurate charge capture and clinical documentation management.Charge Capture Analysis : Monitor and optimize charge capture workflows to ensure all procedures and services are accurately billed, minimizing missed opportunities and revenue leakage.Clinical Documentation Management : Partner with clinical teams to ensure accurate and complete clinical documentation that supports appropriate coding practices and maximizes reimbursement.Claims Review and Denial Prevention : Regularly analyze claims data to identify trends in denials and missed reimbursements; implement proactive solutions to reduce denial rates and appeal claims as necessary.Coding Audit Integrity : Conduct thorough audits of coding practices and records to ensure compliance with all regulatory standards and accuracy in reimbursement. Provide feedback and recommendations for corrective action where discrepancies are identified.Revenue Leakage Prevention Charge Description Master (CDM) Management : Collaborate with CDM management teams to ensure accurate and up-to-date maintenance of the charge description master. Partner with clinical and billing departments to resolve discrepancies or errors.Claim and Reporting Analysis Requirements :
Minimum of 5 years of experience in healthcare revenue cycle processes, including medical billing and claims.Proficiency in coding standards and familiarity with regulatory compliance requirements.Strong analytical skills to identify trends and implement corrective actions.Experience with charge description master management and clinical charge capture workflows.Knowledge of payer guidelines and regulations affecting revenue cycles.Ability to work effectively with interdisciplinary teams to achieve organizational goals.Familiarity with Cerner Revenue Cycle or similar hospital revenue cycle systems.Excellent communication and organizational skills to support training and collaboration.