Revenue Integrity Analyst

Saint Peter’s Healthcare System; New Brunswick (NJ); On-site; USD 91,000 - 150,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Match

Tuition Assistance

Free Parking

Job summary

Saint Peter’s Healthcare System in New Jersey is seeking a Revenue Integrity Analyst to own the Epic charge description master, pricing, and coding workflows. You will maintain charge routing rules and ensure accurate revenue coding across services.

You will identify missing charges, analyze reimbursements, monitor high-risk areas, and develop training for end-users. This full-time role collaborates with Finance and Managed Care on price changes and CDM governance.

Qualifications

• Bachelor's degree in health information management, healthcare administration, finance, business, nursing, or related field.
• 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.

Responsibilities

• 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.
• 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.

Skills

Excel

Data analysis

Communication

Training

Education

Bachelor's degree in health information management, healthcare administration, finance, business, nursing, or related field

Job description

• 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.

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.

Salary Range: 90,771.00-149,739.00USD

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 .