Revenue Integrity Analyst | Patient Accounting | Full Time | HYBRID (On-Site/Remote)

Essential Duties and Responsibilities

• Monitor revenue integrity performance across hospital outpatient, inpatient, emergency, ancillary, specialty clinic, and RHC services.

• Review charge capture, coding, documentation, billing, and claim-edit workflows to identify missed, delayed, duplicate, or inaccurate charges.

• Analyze Epic workqueues, reports, dashboards, edits, and transaction detail to investigate exceptions and support timely resolution.

• Perform focused audits and data validation related to charge reconciliation, claim accuracy, coding edits, medical necessity, modifiers, units, and documentation support.

• Assess revenue cycle workflows for compliance with organizational policies, payer requirements, and applicable federal and state billing regulations.

• Support CAH- and RHC-specific reimbursement workflows, including review of clinic designation, provider enrollment impacts, encounter routing, professional and facility billing, and qualifying visit processes.

• Partner with clinical departments and clinics to develop and maintain charge reconciliation and missing-charge controls.

• Research root causes of recurring denials, edits, underpayments, and revenue variances; recommend corrective actions and monitor outcomes.

• Coordinate with Coding, Patient Financial Services, Compliance, Finance, Information Technology, Health Information Management, and operational leaders to implement workflow improvements.

• Assist with Epic testing, optimization, upgrades, workflow validation, and issue resolution affecting revenue capture or claim integrity.

• Create clear reports, trend analyses, education materials, and presentations for leaders and operational teams.

• Provide education and guidance to staff and providers regarding documentation, charge capture, claim-edit prevention, and revenue integrity processes.

• Track findings, action plans, responsible parties, due dates, and measurable results.

• Maintain confidentiality and comply with privacy, security, compliance, and records-retention requirements.

• Perform other revenue integrity duties as assigned within the scope of the position.

Minimum Qualifications

• Associate degree in health information management, healthcare administration, business, finance, nursing, or a related field; equivalent relevant experience may be considered.

• Three years of experience in revenue integrity, revenue cycle, coding, billing, reimbursement, audit, compliance, or a related healthcare function.

• Demonstrated experience using Epic in a hospital or ambulatory revenue cycle environment.

• Working knowledge of hospital and professional billing workflows, claim edits, coding concepts, medical necessity, denials, and payer requirements.

• Proficiency with spreadsheets, data analysis, report interpretation, and preparation of clear written findings.

Preferred Qualifications

• Bachelor’s degree in a related field.

• Experience supporting a Critical Access Hospital, Rural Health Clinics, and multispecialty physician practices.

• Epic certification, accreditation, or advanced operational experience in relevant clinical or revenue cycle applications.

• Professional credential such as RHIA, RHIT, CCS, CPC, CPMA, CRCR, CHRI, or an equivalent credential.

• Experience with process improvement, audit methodology, project coordination, or healthcare data visualization.

Knowledge, Skills, and Abilities

• Knowledge of revenue cycle operations in rural hospital and clinic settings.

• Understanding of CAH and RHC reimbursement and billing concepts.

• Ability to interpret complex data, identify patterns, and translate findings into practical corrective actions.

• Strong analytical, investigative, organizational, and problem-solving skills.

• Ability to manage multiple priorities, meet deadlines, and document work accurately.

• Strong written and verbal communication skills, including the ability to educate diverse audiences.

• Ability to work independently while building effective cross-functional relationships.

• Sound judgment, attention to detail, discretion, and commitment to ethical conduct.

Key Working Relationships

Works closely with department managers, physicians and advanced practice professionals, nursing, ancillary service departments, pharmacy, supply chain, health information management, coding, billing, patient financial services, compliance, finance, information technology, and external vendors.

Physical and Work Requirements

Work is primarily performed in an office or remote-work environment and requires extended use of a computer, telephone, and standard office equipment. The employee must be able to communicate effectively, review detailed information, and meet established deadlines. Reasonable accommodations may be made to enable qualified individuals to perform the essential functions.