Revenue Integrity Analyst – Payor Edits & Optimization

WVU Medicine; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

SYSTEM West Virginia University Health System is seeking a detail-oriented Billing/Revenue Cycle professional to review charge edits and optimize revenue capture. You will monitor edits across CCI, OCE, MUE, LCD, and NCD policies, collaborating with leadership to train and refine the editing tools.

The role emphasizes data analysis, regulatory compliance, and cross-department coordination to minimize write-offs and maximize accurate reimbursement.

Qualifications

• Two years of billing/revenue cycle experience.
• High School Diploma or equivalent.
• Knowledge of ICD-10, CPT and HCPCS codes.
• Strong analytical skills and Excel/reporting proficiency.
• Ability to communicate with revenue cycle leadership and clinical departments.

Responsibilities

• Manage payor and claim edits (CCI, OCE, MUE, LCD and NCD) promptly and compliantly.
• Track edited accounts, actions, and outcomes; report trends to leadership.
• Monitor denials, appeals, and follow-up activities.
• Assist departments with compliance regarding government regulations for claim edits.
• Collaborate with Revenue Cycle leadership and clinical teams to optimize charge capture.
• Maintain up-to-date payer policy knowledge and communicate changes to leadership.
• Perform root-cause analysis for high-volume edits; coordinate fixes with Epic team.
• Report on volume of edits to support reductions over time.

Skills

Computers proficiency

Medical terminology

ICD-10 CPT HCPCS knowledge

Analytical thinking

Excel and reporting tools

Education

High School diploma or equivalent

Bachelor’s degree in business or healthcare field or Health Information Tech

Tools

Epic Revenue Guardian

Job description

SYSTEM West Virginia University Health System is seeking a detail-oriented Billing/Revenue Cycle professional to review charge edits and optimize revenue capture. You will monitor edits across CCI, OCE, MUE, LCD, and NCD policies, collaborating with leadership to train and refine the editing tools.

The role emphasizes data analysis, regulatory compliance, and cross-department coordination to minimize write-offs and maximize accurate reimbursement.