Senior Revenue Integrity Analyst

Departmen t: Revenue I ntegri ty

Report s T o : Director , Revenue I ntegr i ty

Cost Center / J ob Code : 10000-50131-003004 F L SA Statu s : E x empt

P osit i on Objective :

T he Senior Revenue Integrity Analyst w or k s in the L um i n i s H ealth Revenue I ntegrity department and serve s as the k e y I i aison and subject matter e x pert on all aspect s of hosp i tal charge capture and ent ry , charge integr i ty, an d charge reconc il iat i on proce s ses . This position leads complex revenue integrity initiatives across multiple departments, serves as the primary subject matter expert for charge capture and CDM optimization, and provides strategic recommendations to leadership to improve revenue capture, regulatory compliance, and reimbursement outcomes. Th ey w ill a l ign w ith cl i n i cal l eadersh i p and s erve a s the s ubject matter e x pert regarding billing compl i ance , accuracy of charge capture and integr i ty proc e sses i nc l ud i ng educat i on , audit act i vities , changes, or r i s k of revenue ( regu l atory or coding changes ) and mon i tor i ng of charge capture re l ated metrics to minim i ze revenue lea k age .

E ssent i al J o b Dut i es :

1.    M anage s and trac k s all hosp i tal 3rd party pa y er aud i ts ; performs defense aud i ts and educates c l inica l departments on lo s t pa y ment opportun i t i es

2.    Performs i nternal review of Revenue C y c l e proce s se s

3.    Collects , di s seminates, an d educates cl i n i cal departments on all state and federa l b illing / coding / charging updates

4.    Prov i d es charge capture education to cl i n i cal department s

5.    Perform s CDM audit s in accordance w i th L um i n i s H ealth Chargemaster Revie w Pol i c y

6.    Proficient U s e of Support S y stem s

7.    Efficient ut il ization of b i lling s y stem d atabase to up d ate , Charge Descript i on Master ( CDM) ; ensures broad understanding of all areas of revenue c y cle including pre-AR , actua l ized AR revie w, an d router log i c

8.    Ab il ity to appropr i ate l y ed i t charge s via Charge Router and document action s via note s i n the Reso l ute billing s y s tem .

9.    Demonstrated abil i ty to ut il ize Outlook email and nav i gate in the W ord and E x cel software app l icat i ons .

10.    Competence i n Cod i ng , B i lling and Charge l ntegrity W orkflo w s

11.    Evaluates current charg i ng and coding s tructures in cl i n i cal , cod i ng and Revenue C y cle departments to ensure appropriate capture and reporting of revenue and compl i ance w ith state / federa l government and th i rd-party p a yer requirements

12.    Asse s s the accurac y an d bu il d of all Charge Capture re l ated w orkflo w s i n EP I C , including documentation , automat i on enhancements

13.    Demonstrates the abil i ty to understand and util i ze pa y er rejections and remittance denia l s to e x ecute den i al management

strateg i es to mitigate the r i s k of future denia l s

14.    Serves as the primary escalation point for complex revenue integrity, charge capture, coding, billing, and compliance issues and provides expert guidance to operational and clinical stakeholders

15.    Leads and manages strategic revenue integrity projects and department initiatives designed to improve revenue capture, enhance operational effectiveness, reduce denials, and ensure regulatory compliance

16.    Provides mentorship, guidance, and subject matter expertise to Revenue Integrity Analysts and other revenue cycle professionals; supports skill development and knowledge sharing across the department

17.    Influences operational and leadership decision-making through analysis of revenue integrity trends, audit findings, regulatory requirements, payer activity, and process improvement opportunities

18.    Collaborates with Revenue Integrity leadership to develop, implement, maintain, and continuously improve departmental policies, procedures, standards, and best practices

19.    Collaborates with Revenue Integrity leadership to develop, implement, maintain, and continuously improve departmental policies, procedures, standards, and best practices

20.    Organizational Efficiency

21.    Effectively maintains audit and account activity by ensuring the proper organization, tracking, filing, and documenting of all correspondence

22.    Assists in proactive communication and root cause analysis of challenges impacting final adjudication of claims, including but not limited to system or payer issues

23.    Provides Outstanding Customer Service

24.    Creates a cross-collaborative approach with Billing teams, Coding, HIM, and other key stakeholders to improve charge capture, compliant documentation to substantiate charges, charge reconciliation, and compliant billing of all charges

Ed uc a t io nal/J o b E xpe r i ence R e q u i r e m ents :

• BS i n F i nance , Account i ng or H ealthcare re l ated field preferred

• I n l ieu of BS degree , 1 0 y ears of hospita l Revenue C y cle / Revenue I ntegr i ty e x per i ence preferred

• 5-7 y ear s’ e xpe r ience support i ng Revenue C y cle and Cl i n i cal s y stems

• W or k s w ell in environment w i th firm dead l ines ; results oriented

• Demonstrate s strong k no w ledge of end-to-end revenue cyc l e

• E x perience in EP I C required

• E x perience w i th Microsoft Office , W ord, an d E x ce l

• Ab il ity to commun i cate profess i onall y v i a internet and virtual communicat i on tools

• Coding certification (CPMA, CPC, CBCS, CCS, or equivalent) required . Candidates without certification must obtain an approved certification within 18 months of hire.

Working Conditions, Equipment, Physical Demands:

There i s a reasonable e x pectat i on that emplo y ees i n t h is pos i t i on w i II not be e x posed to   blood-borne pathogens . Reasonab l e accommodation ma y be made to enable ind i viduals w ith
Pay Range
$95,000 — $118,000 USD

Luminis Health Benefits Overview:

• Medical, Dental, and Vision Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Employee Assistance Programs and more
• Benefit offerings based on employment status

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