Revenue Integrity Analyst

PURPOSE STATEMENT

The Revenue Integrity Analyst is responsible for maintaining the integrity of the hospital’s Chargemaster (CDM) and ensuring accurate charge capture, coding support, compliant billing practices, and optimal reimbursement across all hospital departments. This position serves as the primary liaison between Finance, Revenue Cycle, Health Information Management (HIM), Clinical Departments, Compliance, and Information Technology to identify revenue leakage, improve charge accuracy, and support regulatory compliance.

Essential Functions

• Serve as the primary administrator of the hospital Chargemaster (CDM).
• Maintain all hospital charge descriptions, CPT/HCPCS codes, revenue codes, modifiers, units of service, APC assignments, and pricing.
• Cook up annual and ongoing CDM updates based on CMS, AMA CPT, HCPCS, payer and regulatory changes.
• Review new services, supplies, pharmaceuticals, and procedures for appropriate charge creation prior to implementation.
• Ensure inactive or obsolete charges are removed appropriately.
• Cook up annual CPT and HCPCS updates.
• Investigate charge edits and billing errors.
• Analyze denied claims related to charging or billing configuration.
• Collaborate with Denials Management to identify root causes.
• Monitor charge lag and late charge activity.
• Recommend workflow improvements to improve revenue capture.

Routine Audits To Identify Missing charges

• Duplicate charges
• Undercharges
• Overcharges
• Incorrect billing logic
• Revenue leakage

Charge Capture Optimization

• Validate that all billable services are captured accurately.
• Work with clinical departments to improve charging workflows.
• Develop standardized charge reconciliation processes.
• Monitor compliance with charging policies.

Meditech Expanse System Maintenance

• Build and maintain charging dictionaries within Meditech Expanse.
• Participate in Meditech upgrades and optimization initiatives.
• Aid in the implementation of new clinical documentation and charging workflows.

Cohort Testing Of New charge codes

• Pricing updates
• Revenue code changes
• CPT updates
• Modifier logic

Regulatory Compliance

• Assist with internal and external audits related to revenue integrity.
• Ensure Hospital Charging Practices Comply With CMS regulations
• Medicare billing requirements
• Medicaid billing requirements
• National Correct Coding Initiative (NCCI)
• Outpatient Prospective Payment System (OPPS)
• Inpatient Prospective Payment System (IPPS)
• Uniform Billing (UB-04)
• HIPAA
• OIG Compliance Guidance
• Hospital Price Transparency regulations.

Pricing and Financial Analysis

• Maintain hospital pricing methodology.
• Coordinate annual price updates.
• Support strategic pricing initiatives.
• Evaluate reimbursement for new service lines.
• Assist Finance with revenue projections.

Data Analytics

• Provide monthly revenue integrity dashboards to leadership.
• Develop and monitor reports related to:
• Charge lag
• Late charges
• Charge reconciliation
• Missing charges
• Revenue leakage
• CDM accuracy
• Denials by charging issue
• Department charge variance
• Gross revenue trends
• Hospital Price Transparency compliance

Collaboration

• Work closely with Patient Financial Services
• Health Information Management
• Coding
• Clinical Departments
• Pharmacy
• Laboratory
• Radiology
• Surgery
• Emergency Department
• Compliance
• Finance
• Information Technology
• Meditech Analysts

Education

• Educate department leaders on compliant charging practices.
• Train staff on new charge capture workflow.
• Develop charging reference materials.
• Communicate CMS and CPT updates affecting departments.

Quality Improvement

• Participate in continuous improvement initiatives to reduce charge errors
• Improve first-pass claim acceptance
• Decrease denials
• Increase net revenue
• Improve charge reconciliation timeliness
• Enhance documentation supporting billing

Other Functions

• Maintains regular and predictable attendance.
• Performs other essential duties as assigned.
• To accommodate travel, must be able to transport own suitcases and portable computer estimated at 25 lbs.