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Healthcare Revenue Integrity Analyst - Edits & Charge Capture | Remote | Contract

Schedule: Monday - Friday | Full-Time

Position Summary

The Healthcare Revenue Integrity Analyst is responsible for reviewing, analyzing, and resolving billing edits, charge review exceptions, and revenue cycle discrepancies to ensure accurate reimbursement and regulatory compliance. This role serves as a key resource in identifying revenue leakage opportunities, improving charge capture processes, reducing denials, and optimizing revenue cycle performance.

The analyst will work closely with Revenue Integrity, Patient Financial Services, HIM, Coding, Clinical Departments, CDI, and Information Technology teams to support compliant billing practices and maximize reimbursement.

Required Qualifications

• Minimum 3 years of Revenue Integrity, Revenue Cycle, Billing, Coding, or Charge Capture experience within a hospital or health system.
• Experience working claim edit workqueues and billing edits.
• Knowledge of Medicare, Medicaid, and commercial payer reimbursement methodologies.
• Experience researching and resolving charging, coding, and billing discrepancies.
• Understanding of NCCI edits, medical necessity edits, modifier usage, and reimbursement guidelines.
• Experience with Epic Resolute, Epic Revenue Integrity, Cerner, Meditech, or similar hospital billing systems.
• Strong analytical and problem-solving skills.

Preferred Certifications
One or more of the following certifications is preferred:

• CPMA (Certified Professional Medical Auditor)
• CPC (Certified Professional Coder)
• COC (Certified Outpatient Coder)
• CCS (Certified Coding Specialist)
• CRCR (Certified Revenue Cycle Representative)
• RHIT (Registered Health Information Technician)
• RHIA (Registered Health Information Administrator)

Primary Responsibilities

• Review and resolve claim edits and billing exceptions.
• Analyze charging and reimbursement issues impacting revenue cycle performance.
• Identify trends related to denials, underpayments, and revenue leakage.
• Collaborate with Coding, CDI, Revenue Cycle, Clinical Departments, and Patient Financial Services to resolve reimbursement issues.
• Validate compliance with payer regulations, CMS guidelines, and organizational policies.
• Support charge capture improvement initiatives and CDM maintenance activities.
• Perform root cause analysis on recurring billing and reimbursement issues.
• Assist with revenue cycle audits and process improvement initiatives.
• Develop recommendations to improve clean claim rates and reduce denials.
• Monitor and report key revenue integrity performance metrics.

Preferred Background
Candidates with experience in Revenue Integrity, Charge Capture, Revenue Cycle Analytics, Denials Management, Patient Financial Services, Hospital Billing, or HIM Operations are strongly encouraged to apply.