Revenue Integrity Analyst

Saint Peter's Healthcare System; New Brunswick (NJ); Presencial; USD 90.000 - 120.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision insurance

401(k) with company match

Tuition assistance

Descripción de la vacante

Saint Peter's Healthcare System is seeking a Revenue Integrity Analyst to own the Epic charge description master and ensure accurate charging and reimbursement across services. The role includes auditing, pricing updates, and liaison with Clinical and Finance teams to optimize revenue integrity.

Responsibilities include planning annual pricing changes, training end-users on charge capture, and acting as a consultant to clinical departments for new services and orders.

Formación

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

Responsabilidades

• Own the accuracy and integrity of the Epic charge description master, including codes, descriptions, CPT/HCPCS, revenue codes, modifiers, units, and dating.
• Identify and pursue missing charges through late charge analysis and reconciliation reporting; monitor high-risk charging areas.
• Develop and deliver role-based charge capture and reconciliation training for end-users; advise on how new services should be built and charged.
• Perform routine charge audits to ensure proper documentation, charging, coding, billing and reimbursement.
• Lead annual pricing updates with Finance and Managed Care; model price change impact by payer and service line.
• Coordinate build decisions and maintain a centralized log of CDM requests.

Conocimientos

Excel

Charge capture

Charge master knowledge

Communicate findings

Epic system knowledge

Educación

Bachelor's degree in health information management or related field

Herramientas

Epic

Descripción del empleo

Revenue Integrity Analyst

SPHS-Finance Administration

The Revenue Integrity Analyst will:

• 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.

Requirements:

• 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.

We offer competitive base rates that are determined by many factors, including job‑related work experience, internal equity, and industry‑specific market data. In addition to base salary, some positions may be eligible for clinical certification pay and shift differentials.

The salary range listed for exempt positions reflects full‑time compensation and will be prorated based on employment status.

Saint Peter's offers a robust benefits program to eligible employees that will support you and your family in working toward achieving and maintaining secure, healthy lives now and into the future. Benefits include 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, and recognition rewards.

You can take your career to the next level by participating in either a fully paid tuition program or our generous tuition assistance program. Learn more about our benefits by visiting our site at Saint Peter's.