Revenue Integrity Analyst

Blue Cross Blue Shield of Kansas City • Kansas City, MO

2d

About The Position

The Revenue Integrity Analyst ensures that accurate documentation, coding, and risk adjustment practices directly support high quality patient care in Spira Care’s value-based model. This role partners with clinical, operational, and IT teams to strengthen documentation integrity, close care and coding gaps, optimize risk capture, and maintain compliance. By improving data accuracy and streamlining workflows, the analyst helps reduce the administrative burden for care centers and ensures that patient complexity is properly reflected, quality outcomes are supported, and value-based reimbursement is achieved.

Requirements

• High school diploma or equivalent (GED or HiSET)
• Successful completion of a certified medical coding or auditing course and exam
• CPC – Certified Professional Coder
• CPMA - Certified Professional Medical Auditor
• 3-5 years of experience as a coder
• Requires travel to all Spira Care areas (as needed)
• Excellent interpersonal and communication skills
• Solid computer skills, including proficiency with Microsoft software
• Strong analytical and problem-solving skills
• Detail-oriented

Nice To Haves

• Bachelor's degree in healthcare related field
• CRC – Certified Risk Coder

Responsibilities

• Manages revenue integrity support for physicians, Advanced Practice Providers (APPs) and other providers by providing education on documentation and coding to the highest level of service being rendered.
• Manages the complete revenue cycle for Spira Care Outpatient Services, which includes centralized functions such as coding, claims, and patient billing to improve efficiencies and ensure compliance.
• Ensures compliance by adhering to complex medical guidelines and payer rules.
• Collaborates across clinical operations and IT to ensure accurate and comprehensive clinical documentation that supports risk adjustment, quality performance, and value‑based reimbursement.
• Ensures documentation integrity by closing coding‑related gaps and maintains compliance within value‑based care models.
• Ensures accurate and compliant coding practices with emphasis on risk adjustment Hierarchical Condition Category (HCC), chronic condition management, and quality measure alignment.
• Partners with providers to improve documentation specificity and capture clinically relevant diagnoses that impact patient outcomes and value‑based performance.
• Provides education and feedback to providers on documentation best practices, risk score capture, documentation standards, and quality measure requirements to support accurate representation of patient complexity and care needs.
• Reviews coding, documentation, and quality performance data to identify trends, address deficiencies, and support accurate risk adjustment and quality reporting.
• Maintains adherence to compliance standards related to coding, documentation, risk adjustment, and quality programs.
• Ensures internal processes meet the expectations of value‑based programs.
• Supports internal and external audits related to documentation quality, HCC coding, and value‑based contract performance, working with providers and teams to implement corrective action plans when needed.
• Analyzes and ensures code drops are correct for all services rendered.

Benefits

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED