Revenue Integrity Analyst (Medical Biller)
About The Position
Guidehouse is seeking a Revenue Integrity Analyst (Medical Biller) with strong billing, coding, and revenue cycle expertise to support the modernization of MHS GENESIS, the DoD’s enterprise EHR. The role ensures accurate billing, compliant charge capture, and efficient claim resolution by analyzing data, auditing documentation, and collaborating with clinical, coding, IT, and financial teams across the Military Health System. Responsibilities of this role are as follows, to include but not limited to: Revenue Integrity & Charge Capture Optimize and validate MHS GENESIS / Cerner charge capture workflows, CDM logic, billing rules, and revenue cycle configuration. Conduct charge capture validation, reconciliation of clinical activity to billing outputs, and identification of DNFB risks and revenue leakage. Audit documentation and coding (ICD‑10‑CM, CPT/HCPCS, modifiers) to ensure NCCI, LCD/NCD, TRICARE, and DHA compliance. Billing, Claims, & Denial Management Investigate claim edits and denials using Alpha II, SSI, or related tools; identify root causes and implement sustainable solutions. Perform payer remittance analysis to uncover denial trends, modifier issues, bundling errors, and reimbursement gaps. Support UB‑04 and CMS‑1500 billing accuracy and troubleshoot errors impacting payer acceptance or reimbursement. Data Analytics & Reporting Analyze clinical, financial, and operational data to identify trends and develop data‑driven recommendations for revenue improvement. Use MHS GENESIS/Cerner analytics tools (HealtheAnalytics, HDI) to interpret dashboards and monitor performance metrics. Prepare executive‑level reporting and visualizations to communicate findings, risks, and remediation strategies. Cross‑Functional Collaboration Partner with coding teams, clinicians, IT analysts, billing offices, and leadership to resolve issues and ensure standardized workflows. Participate in or lead enterprise-level remediation planning, including root cause analysis, corrective action tracking, and workflow optimization. Provide staff education on coding, documentation requirements, and revenue cycle best practices. Process Improvement Recommend and implement workflow improvements to reduce denials, increase first-pass payment rates, and enhance compliance. Identify and escalate systemic issues affecting charge capture, coding, billing, or payer processing.
Requirements
- Must be able to OBTAIN and MAINTAIN a Federal or DoD "PUBLIC TRUST"; candidates must obtain approved adjudication of their PUBLIC TRUST prior to onboarding with Guidehouse. Candidates with an ACTIVE PUBLIC TRUST or SUITABILITY are preferred.
- Bachelors Degree
- FOUR (4) or more years of Revenue Cycle Management (RCM) build experience, including troubleshooting, system reconfiguration, and/or project management.
Nice To Haves
- Bachelor’s Degree in Business, Management, Healthcare Administration, Business Analysis, Statistics, or related field
- Proficiency in ICD‑10‑CM, CPT/HCPCS, modifiers, NCCI, and federal billing regulations (TRICARE, DHA).
- Understanding of Chargemaster (CDM) structure and charge reconciliation processes.
- Experience with MHS GENESIS / Cerner, charge capture, billing workflows, and revenue integrity functions.
- Strong skills in denial root cause analysis, remittance interpretation, and claim lifecycle management
- Familiarity with claim scrubber tools, billing systems, and payer edit logic.
- Strong analytical and critical‑thinking skills with ability to interpret complex data and interpret Excel‑based or system‑generated dashboards.
- Effective communication skills with the ability to train, educate, and influence stakeholders.
- Understanding of healthcare billing, medical necessity, and revenue cycle operations.
- Experience working within the Military Health System (MHS) or other federal health systems.
- Background in hospital or professional billing environments.
- Certifications such as CPC, CCS, CPMA, or RHIT/RHIA.
- Prior consulting experience or participation in large‑scale EHR or revenue cycle implementations
Responsibilities
- Revenue Integrity & Charge Capture Optimize and validate MHS GENESIS / Cerner charge capture workflows, CDM logic, billing rules, and revenue cycle configuration.
- Conduct charge capture validation, reconciliation of clinical activity to billing outputs, and identification of DNFB risks and revenue leakage.
- Audit documentation and coding (ICD‑10‑CM, CPT/HCPCS, modifiers) to ensure NCCI, LCD/NCD, TRICARE, and DHA compliance.
- Investigate claim edits and denials using Alpha II, SSI, or related tools; identify root causes and implement sustainable solutions.
- Perform payer remittance analysis to uncover denial trends, modifier issues, bundling errors, and reimbursement gaps.
- Support UB‑04 and CMS‑1500 billing accuracy and troubleshoot errors impacting payer acceptance or reimbursement.
- Analyze clinical, financial, and operational data to identify trends and develop data‑driven recommendations for revenue improvement.
- Use MHS GENESIS/Cerner analytics tools (HealtheAnalytics, HDI) to interpret dashboards and monitor performance metrics.
- Prepare executive‑level reporting and visualizations to communicate findings, risks, and remediation strategies.
- Partner with coding teams, clinicians, IT analysts, billing offices, and leadership to resolve issues and ensure standardized workflows.
- Participate in or lead enterprise-level remediation planning, including root cause analysis, corrective action tracking, and workflow optimization.
- Provide staff education on coding, documentation requirements, and revenue cycle best practices.
- Recommend and implement workflow improvements to reduce denials, increase first-pass payment rates, and enhance compliance.
- Identify and escalate systemic issues affecting charge capture, coding, billing, or payer processing.
Benefits
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave and Adoption Assistance
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Student Loan PayDown
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Mobility Stipend
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
