Senior Revenue Integrity Analyst

About the Role

The Sr. Revenue Integrity Analyst provides subject matter expertise in charge capture, CDM application, compliance, and reimbursement. The Sr. Revenue Integrity Analyst leads audits, supports governance, and drives revenue optimization initiatives across clinical departments while ensuring alignment with CMS and payer requirements.

Minimum Job Qualifications

• Education: Bachelor's Degree (A combination of relevant certification(s) and demonstrated work experience may substitute for the required degree.)
• Experience: 5+ years hospital revenue cycle, charge capture, or CDM

Preferred Job Qualifications

• Licensure or certifications: CPC, CCS, RHIT/RHIA, Epic Certification

Knowledge, Skills, and Abilities

• Advanced knowledge of CPT/HCPCS and reimbursement
• Expertise in CDM structure and clinical application
• Strong auditing and compliance background
• Ability to analyze financial impact of charge issues
• Experience with workflow redesign and optimization
• Advanced Excel and data analysis skills
• Ability to lead training and education initiatives
• Strong communication across clinical and executive teams
• Knowledge of CMS, Medicaid, and payor rules
• Experience with dashboards and reporting

Essential Tasks and Responsibilities

• Monitor departmental charge capture accuracy to ensure thorough analysis of work queues and reconciliation reports
• Identify charge capture gaps, workflow issues, and systemic revenue loss risks
• Provide guidance, training, and education to clinical departments
• Partner with CDM team on updates and recommend improvements
• Conduct pre/post bill audits to validate charge mappings and billing rules
• Analyze trends and root causes impacting reimbursement, compliance, and financial performance
• Quantify revenue at risk and assess the financial impact of charge and develop corrective action plans to optimize revenue initiatives
• Ensure CMS and regulatory compliance
• Support CPT/HCPCS annual updates
• Collaborate cross-functionally with Coding, IT, Finance, Compliance and leadership to resolve issues and improve processes
• Support governance committees
• Develop reports and dashboards and deliver data-driven recommendations to leadership
• Performs other duties as assigned

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
• Vision: Moderate, Frequently 31-65% of time
• Kneeling/Stooping/Bending: Occasionally 0-30%
• Standing/Walking: Occasionally 0-30%
• Pushing/Pulling: Occasionally 0-30%
• Intensity of Work: Frequently 31-65%
• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving