Senior Analyst, Quality Analysis

Northeast Georgia Health System; Atlanta (GA); Vor Ort; USD 95.000 - 135.000; Vollzeit

Zusammenfassung

Northeast Georgia Health System in Atlanta, GA, seeks 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, ensuring alignment with CMS and payer requirements.

Minimum qualifications include a Bachelor's degree and 5+ years in hospital revenue cycle.

Qualifikationen

• Bachelor's degree required.
• 5+ years in hospital revenue cycle, charge capture, or CDM.
• A combination of relevant certification(s) and demonstrated work experience may substitute for the required degree.

Aufgaben

• Monitor department charge capture accuracy and reconcile reports.
• Identify charge capture gaps, workflow issues, and revenue risk.
• 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, compliance, and financial performance.
• Quantify revenue at risk and assess financial impact to optimize revenue initiatives.
• Ensure CMS and regulatory compliance.
• Support CPT/HCPCS annual updates.
• Collaborate cross-functionally with Coding, IT, Finance, Compliance and leadership.
• 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

Data analysis

Excel

Training & education

Communication

CMS/payor rules

Dashboards & reporting

Ausbildung

Bachelor's Degree

Jobbeschreibung

Job Category: Revenue Cycle

Work Shift/Schedule:8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role

Job Summary

The Sr. Revenue Integrity Analyst provides subject matter expertise in charge capture, CDM application, compliance, and reimbursement. The Sr. Revenue Integrity Analyst leads audits, supports governance, and drives revenue optimization initiatives across clinical departments while ensuring alignment with CMS and payer requirements

Minimum Job Qualifications

Licensure or other certifications:

Educational Requirements:

Bachelors Degree

Minimum Experience:

5+ years hospital revenue cycle, charge capture, or CDM

Other:

A combination of relevant certification(s) and demonstrated work experience may substitute for the required degree.

Preferred Job Qualifications

Preferred Licensure or other certifications:

CPC, CCS, RHIT/RHIA, Epic Certification.

Preferred Educational Requirements:

Preferred Experience:

Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Advanced knowledge of CPT/HCPCS and reimbursement
• Expertise in CDM structure and clinical application
• Strong auditing and compliance background
• Ability to analyze financial impact of charge issues
• Experience with workflow redesign and optimization
• Advanced Excel and data analysis skills
• Ability to lead training and education initiatives
• Strong communication across clinical and executive teams
• Knowledge of CMS, Medicaid, and payor rules
• Experience with dashboards and reporting

Essential Tasks and Responsibilities

• Monitor departmental charge capture accuracy to ensure thorough analysis of work queues and reconciliation reports.
• Identify charge capture gaps, workflow issues, and systemic 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, compliance, and financial performance.
• Quantify revenue at risk and assess the financial impact of charge 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, Finanace, 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.

Physical Demands

Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

Vision: Moderate, Frequently 31-65% of time

Kneeling/Stooping/Bending: Occasionally 0-30%

Standing/Walking: Occasionally 0-30%

Pushing/Pulling: Occasionally 0-30%

Intensity of Work: Frequently 31-65%

Job Requires

• Reading, Writing, Reasoning, Talking, Keyboarding, Driving

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.