Revenue Integrity Lead — Optimize Coding & Compliance

Northeast Georgia Health System; United States; Remote; USD 90.000 - 120.000; Vollzeit

Zusammenfassung

Northeast Georgia Health System is seeking a Sr. Revenue Integrity Analyst to provide subject matter expertise in charge capture, CDM application, compliance, and reimbursement.

You will lead audits, support governance, and drive revenue optimization across clinical departments while aligning with CMS and payer requirements. The role demands 5+ years in hospital revenue cycle with strong Excel and data analysis capabilities, plus the ability to train and elevate cross-functional teams.

Qualifikationen

• Bachelor's degree required; relevant certification may substitute.
• 5+ years hospital revenue cycle, charge capture, or CDM experience.
• Experience with CMS/payor rules and compliance.
• Strong auditing and data analysis skills.

Aufgaben

• Monitor department charge capture accuracy and analyze work queues and reconciliation reports.
• Identify charge capture gaps, workflow issues, and revenue loss risks.
• Provide guidance, training, and education to clinical departments.
• Partner with CDM team on updates and recommend improvements.
• Conduct pre/post bill audits to validate charge mappings and billing rules.
• Analyze trends and root causes impacting reimbursement and financial performance.
• Quantify revenue at risk and develop corrective action plans to optimize revenue initiatives.
• Ensure CMS and regulatory compliance.
• Support CPT/HCPCS annual updates.
• Collaborate cross-functionally with Coding, IT, Finance, Compliance and leadership to resolve issues and improve processes.
• Support governance committees.
• Develop reports and dashboards and deliver data-driven recommendations to leadership.
• Performs other duties as assigned.

Kenntnisse

CPT/HCPCS knowledge

CDM knowledge

Auditing & compliance

Financial impact analysis

Workflow redesign

Excel & data analysis

Training & education

Communication with executives

CMS & payor rules

Dashboards & reporting

Ausbildung

Bachelor's Degree

Jobbeschreibung

Northeast Georgia Health System is seeking a Sr. Revenue Integrity Analyst to provide subject matter expertise in charge capture, CDM application, compliance, and reimbursement.

You will lead audits, support governance, and drive revenue optimization across clinical departments while aligning with CMS and payer requirements. The role demands 5+ years in hospital revenue cycle with strong Excel and data analysis capabilities, plus the ability to train and elevate cross-functional teams.