Revenue Integrity Analyst III

Responsibilities

• Leads investigations of systemic billing edits, high-dollar revenue discrepancies, and specialty-specific coding risks; develops recommendations for long-term corrective action.
• Designs and oversees charge capture improvement projects across multiple service lines; ensures sustainable improvements to documentation, charging practices, and Epic workflows.
• Develops advanced dashboards and predictive analytics models to monitor denial trends, charge lag, missed charges, and net revenue opportunities. Provides actionable insights to senior leadership.
• Performs complex cost-benefit analyses to evaluate the financial impact of revenue improvement proposals, payer policy changes, and operational redesigns.
• Leads payer and internal audits, ensuring thorough documentation, effective responses, and sustainable corrective actions. Supports escalations of payment policy or denial issues to senior payer relations leadership.
• Collaborates with Compliance, Legal, and CDM teams to establish governance structures, implement billing corrections, and ensure adherence to corporate initiatives and regulatory requirements.
• Serves as the senior analyst for multiple high-volume or high-risk service lines; acts as a system resource on complex reimbursement and compliance challenges.
• Led quarterly and ad-hoc reviews with operational executives to present findings and recommendations. Mentors Analysts I and II, providing technical guidance, coaching, and quality assurance for their work.

Qualifications

• Seven (7) years of progressive experience in revenue cycle, billing compliance, healthcare reimbursement, or financial analysis and one of the certifications listed below OR Ten (10) years of progressive experience in revenue cycle, billing compliance, healthcare reimbursement, or healthcare financial analysis in lieu of education and certification.
• Bachelor’s degree in finance, Healthcare Administration, Business, Nursing, or related field in lieu of experience and certifications.
• AHIMA-CCS or AAPC-CPC or CMC or AHIMA-RHIT or AHIMA-RHIA in lieu of bachelor’s degree.