Revenue Integrity Analyst

Avera; Sioux Falls (SD); On-site; USD 53,000 - 80,000; Full time

Benefits offered by this job

PTO from day 1

Up to 5% retirement match

Career development

Job summary

Avera Downtown Building-Sioux Falls is seeking a Revenue Integrity Analyst to enhance financial performance across the revenue cycle. You will design dashboards, perform audits, and drive improvements in charge capture, denials management, and payer reimbursement.

The role collaborates with clinical, billing, coding, IT, and payer relations to ensure accurate submissions, timely reporting, and compliance with regulatory standards.

Qualifications

• Ability to communicate effectively with others and collaborate across teams.
• Experience in healthcare revenue cycle analytics, charge auditing, or payment integrity.
• Knowledge of healthcare billing, denial management, and payer reimbursement methodologies.

Responsibilities

• Design, maintain, and enhance dashboards and scorecards for denials, write-offs, payer performance, and charge activity.
• Conduct audits and Revenue Guardian checks to validate charge accuracy and completeness.
• Monitor and resolve Discharged Not Billed (DNB) accounts to ensure timely claim submission.
• Investigate denials and underpayments, identify root causes, and recommend process improvements.
• Manage appeals for underpaid claims, track outcomes, and report on recovery efforts and payment trends.
• Review high-dollar write-offs for appropriateness and elevate discrepancies as needed.
• Oversee Post-Service SCAs to ensure reimbursement accuracy and adherence to contract terms.
• Partner with clinical, operational, and payer relations teams to resolve discrepancies and improve documentation.
• Participate in audits and projects aimed at financial optimization and revenue integrity.

Skills

Communication skills

Analytical skills

Attention to detail

Education

Associate's degree in Healthcare Administration, Finance, Business Analytics, or related field

Bachelor's degree (preferred)

Tools

Power BI

Tableau

Excel

Epic Reporting Tools

Job description

Sioux Falls, SD

Full time

R-260027254

Location:

Avera Downtown Building-Sioux Falls

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$25.50 - $38.25

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Revenue Integrity Analyst is responsible for enhancing financial performance, ensuring accurate charge capture, and securing appropriate reimbursement across the revenue cycle. This role combines expertise in analytics, charge auditing, and payment integrity to support strategic decision-making, operational efficiency, and compliance. The analyst collaborates with clinical, billing, coding, IT, and payer relations teams to identify trends, resolve discrepancies, and drive continuous improvement across Hospital Billing (HB) and Professional Billing (PB) services.

What you will do

• Design, maintain, and enhance dashboards and scorecards for denials, write-offs, payer performance, and charge activity. Analyze trends and translate complex data into actionable insights for stakeholders.
• Conduct audits and Revenue Guardian checks to validate charge accuracy and completeness. Perform payer-specific audits and monitor ED Discharge and Charge Tracker Reports.
• Monitor and resolve Discharged Not Billed (DNB) accounts to ensure timely claim submission.
• Investigate denials and underpayments, identify root causes, and recommend process improvements.
• Manage appeals for underpaid claims, track outcomes, and report on recovery efforts and payment trends.
• Review high-dollar write-offs for appropriateness and elevate discrepancies as needed.
• Oversee Post-Service Single Case Agreements (SCAs) to ensure reimbursement accuracy and adherence to contract terms.
• Partner with clinical, operational, and payer relations teams to resolve discrepancies and improve documentation.
• Participate in audits, strategic initiatives, and projects aimed at financial optimization and revenue integrity.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• Associate's in Healthcare Administration, Finance, Business Analytics, or related field and/or 2-3 years of experience in healthcare revenue cycle analytics, charge auditing, or payment integrity.
• Two to three years experience in healthcare revenue cycle analytics, charge auditing, or payment integrity.
• Knowledge of healthcare billing, denial management, and/or payer reimbursement methodologies.

Preferred Education, License/Certification, or Work Experience:

• Bachelor's
• Certified Revenue Cycle Representative (CRCR) - Healthcare Finance Management Association (HFMA) Upon Hire or
• Certified Specialist Payment & Reimbursement (CSPR) - Healthcare Finance Management Association (HFMA) Upon Hire
• Proficiency in data visualization tools (e.g. Power BI, Tableau) and Excel
• Experience with Epic reporting tools (e.g., SlicerDicer, Reporting Workbench, Clarity, billing and contract modules)

Expectations and Standards

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [e-mail].

At Avera, the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward.

The policy of Avera to provide opportunities for all qualified employees or applicants without regard to disability and to provide reasonable accommodations for all employees or applicants who may be disabled. Avera is committed to ensuring compliance in accordance with the Americans with Disability Act. For assistance, please contact HR Now at 605-504-4444.

Additional Notices

For TTY, dial 711

Avera is an Equal Opportunity/Affirmative Action Employer: Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity.