[Remote] Revenue Integrity Analyst

Note: The job is a remote job and is open to candidates in USA. Saint Peter’s Healthcare System is hiring a Revenue Integrity Analyst to maintain the accuracy of its chargemaster and revenue processes. The role identifies missing charges and reimbursement variances, audits charge capture, trains clinical staff, and leads pricing updates and revenue integrity coordination.

Responsibilities

• Own the accuracy and integrity of the Epic charge description master, including charge codes, descriptions, CPT/HCPCS assignment, revenue codes, modifiers, units of service, and effective dating. Maintain fee schedule groups and pricing records; ensure price changes are applied to the correct entities. Maintain charge routing rules, charge triggers, and order-entry linkage
• Identify and pursue missing charges through late charge analysis, revenue and usage variance review, and department reconciliation exception reporting. Analyze reimbursement variances where the root cause is charge or CDM related. Monitor high-risk charging areas on a defined cadence for high-dollar areas
• Develop and deliver role-based charge capture and reconciliation training for all end-users. Serve as first-line consultant to clinical departments on how a new service, order, supply, or drug should be built, charged, and reconciled
• Perform routine charge audits validating that services provided are documented, charged, coded, billed, and reimbursed correctly and consistently. Performs any other audits as requested
• Lead the annual pricing update process in partnership with Finance and Managed Care, including modeling of price change impact by payer, service line, and volume
• Serve as operational lead to the Financial Integrity Committee. Ensure that build decisions are coordinated amongst all parties. Maintain a centralized log of CDM requests

Skills

• Bachelor's degree in health information management, healthcare administration, finance, business, nursing, or a related field; equivalent directly relevant experience may be substituted
• Minimum five (5) years of hospital revenue cycle experience with direct chargemaster, revenue integrity, or hospital billing responsibility
• Demonstrated working knowledge of CPT, HCPCS, revenue codes, modifiers, UB-04 claim structure, NCCI and MUE edits, and OPPS/APC methodology
• Demonstrated ability to analyze charge, revenue, and reimbursement data and to communicate findings to both clinical and financial audiences
• Demonstrated experience training or advising non-financial clinical staff on charge capture
• Strong Excel skills; ability to work with large charge and claim data extracts

Benefits

• Some positions may be eligible for clinical certification pay and shift differentials.
• Medical, dental, and vision insurance
• Savings accounts
• Voluntary benefits
• Wellness programs and discounts
• Paid life insurance
• Generous 401(k) match
• Adoption assistance
• Back-up daycare
• Free onsite parking
• Recognition rewards
• Either a fully paid tuition program or the generous tuition assistance program

Company Overview