Revenue Integrity Analyst II

R1 RCM

1d•$46,587 - $66,107

About The Position

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Revenue Integrity Analyst II, you will plays a key role in maintaining the accuracy, compliance, and efficiency of the charge master. Every day you will be responsible for responsible for conducting in-depth audits, analyzing complex billing issues and supporting departments in ensuring accurate charge capture and reimbursement. Success in this role involves developing expertise in Excel analytics, mastering charge capture audits, and staying current with regulatory changes and payer requirements. Doing so by collaborating effectively with cross-functional teams and executive stakeholders in a dynamic environment. Here’s what you will experience working as a Revenue Integrity Analyst II: Prepares Excel analysis, including V-Lookups and pivot tables. Gathers and compiles data in a systematic fashion, clearly documenting assumptions, and validating accuracy of information to resolve inconsistencies. Evaluate and implement charge requests with appropriate CPT/HCPCS codes, revenue codes, and pricing, ensuring alignment with clinical services and coding/billing guidelines. Conducts Charge Capture Audits: Review and analyze patient records, billing data, and financial statements to ensure charge and coding compliance. Identify discrepancies or errors and develop action plan for future state resolution. Analyzes data to identify likely relationships, summarizes data and prepares summary materials for discussion with clinical and finance teams. Monitor regulatory changes and payer updates that may impact charge master and revenue integrity. Collaborates with various departments to resolve CDM or RI discrepancies (Utilization Management (UM), Clinical Documentation Integrity (CDI), RCM, Coding Services, Clinical Departments, and Health Information Management (HIM)). Serve as a liaison during system upgrades, new service implementation, and pricing reviews. Executive stakeholders will include Chief Financial Officer (CFO), Chief Compliance Officer (CCO), and Chief Medical Officer (CMO).

Requirements

Expertise in charge description master, CPT/HCPCS, NCCI, MUE, pricing, and payer contracts.
Strong skills in V-Lookups and pivot tables.
Systematic data gathering, compilation, and validation.
Accurate documentation and data accuracy.
Understanding of billing and revenue recognition.
Conducting charge capture audits and identifying discrepancies.
Analyzing data and summarizing findings.
Running and extracting accurate reports.
Working with various departments (UM, CDI, RCM, etc.).
Strong verbal and written skills.
Problem-Solving: Developing action plans for discrepancies.
Stakeholder Management: Interacting with executive stakeholders (CFO, CCO, CMO).
Certification: CPC or COC + ROCC or at least experience in RAD ONC

Responsibilities

Prepares Excel analysis, including V-Lookups and pivot tables.
Gathers and compiles data in a systematic fashion, clearly documenting assumptions, and validating accuracy of information to resolve inconsistencies.
Evaluate and implement charge requests with appropriate CPT/HCPCS codes, revenue codes, and pricing, ensuring alignment with clinical services and coding/billing guidelines.
Conducts Charge Capture Audits: Review and analyze patient records, billing data, and financial statements to ensure charge and coding compliance.
Identify discrepancies or errors and develop action plan for future state resolution.
Analyzes data to identify likely relationships, summarizes data and prepares summary materials for discussion with clinical and finance teams.
Monitor regulatory changes and payer updates that may impact charge master and revenue integrity.
Collaborates with various departments to resolve CDM or RI discrepancies (Utilization Management (UM), Clinical Documentation Integrity (CDI), RCM, Coding Services, Clinical Departments, and Health Information Management (HIM)).
Serve as a liaison during system upgrades, new service implementation, and pricing reviews.
Executive stakeholders will include Chief Financial Officer (CFO), Chief Compliance Officer (CCO), and Chief Medical Officer (CMO).