Senior Revenue Integrity Analyst
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Job Description
Senior Revenue Integrity Analyst ensuring compliance and leading revenue optimization initiatives at Northeast Georgia Health System. Provides guidance and audits across clinical departments for financial accuracy.
Responsibilities:
- Provides subject matter expertise in charge capture, CDM application, compliance, and reimbursement.
- Leads audits, supports governance, and drives revenue optimization initiatives across clinical departments.
- Ensures alignment with CMS and payer requirements.
- Monitors departmental charge capture accuracy to ensure thorough analysis of work queues and reconciliation reports.
- Identifies charge capture gaps, workflow issues, and systemic revenue loss risks.
- Provides guidance, training, and education to clinical departments.
- Partners with CDM team on updates and recommend improvements.
- Conducts pre/post bill audits to validate charge mappings and billing rules.
- Analyzes trends and root causes impacting reimbursement, compliance, and financial performance.
- Quantifies revenue at risk and assess the financial impact of charge and develops corrective action plans to optimize revenue initiatives.
- Ensures CMS and regulatory compliance.
- Supports CPT/HCPCS annual updates.
- Collaborates cross-functionally with Coding, IT, Finance, Compliance and leadership to resolve issues and improve processes.
- Supports governance committees.
- Develops reports and dashboards and delivers data-driven recommendations to leadership.
- Performs other duties as assigned.
Requirements:
- Bachelors Degree
- 5+ years hospital revenue cycle, charge capture, or CDM
- A combination of relevant certification(s) and demonstrated work experience may substitute for the required degree.
- CPC, CCS, RHIT/RHIA, Epic Certification preferred.
- 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.
Benefits:
- Opportunities start here.
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