Senior Revenue Integrity Analyst - Mon - Fri Days - 100% Remote

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.

Responsibilities

• Maintain departmental charge capture accuracy through 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 charges to develop corrective action plans.
• 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.

Requirements

• Licensure or other certifications: Required - CPC, CCS, RHIT/RHIA, Epic Certification.
• Education: Required - Bachelors Degree.
• Experience: Required - 5+ years hospital revenue cycle, charge capture, or CDM.

Qualifications

• Preferred Licensure or other certifications: Preferred - CPC, CCS, RHIT/RHIA, Epic Certification.
• Preferred Education: Preferred - Preferred Experience: Other.

Skills

• Advanced knowledge of CPT/HCPCS and reimbursement.
• Expertise in CDM structure and clinical application.
• Strong auditing and compliance background.
• Experience with workflow redesign and optimization.
• Advanced Excel and data analysis skills.
• Strong communication across clinical and executive teams.
• Knowledge of CMS, Medicaid, and payor rules.
• Experience with dashboards and reporting.

Pay

Negotiable based on experience and qualifications.

Schedule

8 Hr Morning - Afternoon