MAJOR RESPONSIBILITIES/ESSENTIAL FUNCTIONS
The Revenue Integrity Analyst is responsible for supporting the hospital’s revenue cycle by ensuring accurate charge capture, compliant billing practices, and optimal reimbursement. This role analyzes clinical and financial data to identify revenue leakage, resolve billing discrepancies, and ensure adherence to regulatory and payer requirements within an acute care hospital environment.
The analyst collaborates with clinical departments, coding, patient financial services, and compliance teams to maintain revenue integrity across all service lines.
Key Responsibilities:
- Monitor and analyze charge capture processes to identify missing, incorrect, or duplicate charges.
- Conduct revenue integrity audits across hospital departments including inpatient, outpatient, and ancillary services.
- Collaborate with coding, HIM, and patient financial services teams to ensure accurate coding and billing compliance.
- Analyze payer policies and regulatory requirements to ensure compliance with federal and state guidelines.
- Participate in process improvement initiatives to enhance revenue cycle efficiency and reduce revenue leakage
- Provide education and guidance to clinical and operational staff regarding proper charge capture and documentation.
- CDM maintenance and governance, including adding, revising, and retiring charge codes
- Charge capture review and reconciliation to ensure services are billed appropriately
- Compliance monitoring related to CPT/HCPCS coding, payer guidelines, and regulatory requirements
- Pricing validation and updates within the Charge Description Master
- Coordination with departments to ensure accurate charge mapping and revenue capture
- Charge audits and variance analysis to identify revenue leakage or compliance risks
- Strong knowledge of medical terminology, coding guidelines, NCCI edits, and billing regulations.
- Strong communication and interpersonal skills, with the ability to work collaboratively with clinical and administrative staff.
- Ability to prioritize tasks and manage time effectively in a fast-paced environment.
- Performs other job related duties as assigned.
JOB QUALIFICATIONS
Minimum Education (Indicate minimum education or degree required.)
- Bachelor’s Degree in Healthcare Administration, Health Information Management, Finance, Business Administration, or a related field
Preferred Education (Indicate preferred education or degree required.)
- Master’s degree in Healthcare Administration, Business Administration, or related field
Required work Experience and Qualification (Indicate minimum years of job experience, skills or abilities required for the job.)
- Strong understanding of hospital revenue cycle operations including charge capture, coding, billing, and reimbursement.
- Knowledge of Medicare, Medicaid, and commercial payer regulations
- Experience with electronic health records (EHR) and hospital billing systems
- Advanced analytical and problem-solving skills
- Strong proficiency in Microsoft Excel and data analysis tools
- Ability to interpret financial, clinical, and operational dataPossess excellent written/verbal communication skills in addition to the ability to work with minimal supervision
Preferred Work Experience and Qualifications (Indicate preferred years of job experience, skills or abilities required for the job.)
- Proven experience in charge capture, medical billing, or a similar role within a hospital setting 3-5 years' experience.Certified Revenue Integrity Professional (CRIP)
- Certified Coding Specialist (CCS)
- Certified Professional Coder (CPC)
- Certified Healthcare Financial Professional (CHFP)
Required Licensure, Certification, Registration or Designation (List any licensure or certification required and specify name of agency.)
- Current Los Angeles County Fire Card (or must be obtained within 30 days of employment)
- Assault Response Competency (ARC) required (within 30 days of hire)
Shift: Days
Hours: 8
Weekly Hours: 40
Type: Exempt
FTE: 1.0
