Revenue Integrity Analyst at Prevea Health

Ashwaubenon, Wisconsin, United States -

Full Time

Start Date

Immediate

Expiry Date

16 Mar, 26

Salary

0.0

Posted On

16 Dec, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Revenue Cycle, Coding, Charge Capture, Regulatory Compliance, Data Analysis, Reporting, Charge Description Master, Pricing Expertise, Audit Skills, Problem-Solving, Cross-Functional Collaboration, Communication, Project Management, Process Improvement, Attention to Detail, Documentation

Industry

Hospitals and Health Care

Description

Revenue Integrity Manager -------------------------------------------------------------------------------- Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health—they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care. Job Summary The Revenue Integrity Manager will lead the development of the revenue integrity function and is responsible for the oversight and management of the revenue integrity team. This position is accountable for optimizing revenue by ensuring accurate, compliant, and efficient charge capture and billing practice. The Revenue Integrity Manager will improve the performance of revenue cycle processes including developing best practices, coordinating issue resolution, establishing proactive lost revenue prevention measures, and monitoring compliance. The ideal candidate has a strong understanding of EPIC systems, coding standards, and billing regulations across both physician and facility revenue streams. What you will do * Utilize data analytics and process improvement techniques to identify potential revenue leakage and support accurate charge capture. Use EPIC reporting tools to extract and analyze charge data. Perform extensive data mining, develop reports, review trends, and recommend enhancements to resolve lost revenue. * Manage a team of chart reviewers. Design and implement a chart review program to ensure completeness of records, appropriateness of billing, and compliance with regulatory and payer requirements. * Identify coding and documentation discrepancies to provide recommendations. Monitor for positive or negative trends in coding, charge capture and/or editing processes. Analyze denial trends related to charge capture and billing. Collaborate with coding, billing, and clinical teams to identify root causes and implement corrective actions. * Maintain documentation of audit findings, trends, and resolutions to support compliance and training efforts. Measure key performance indicators (KPIs). Prepare reports and present findings and recommendations to management. * Oversee and maintain the CDM, identifying opportunities for missed revenue. Including an annual comparison of Prevea’s CDM and supply/implant costs to payer contracts. Develop and maintain all retail pricing. Participate in service line pricing reviews. * Research and stay current on CMS, federal and state regulations, payor guidelines, ensuring compliance and alignment with charge, coding and charge edits. Complete analysis of revenue impacts as a result of CMS payment changes. * Performs full range of managerial responsibilities which may include but not be limited to interviewing, hiring, coaching and developing employees; planning, assigning and directing work. Encourage innovation, teamwork, fiscal responsibility, and high-quality work. Education Qualifications * Bachelor's Degree Business or Healthcare related; or Associate's degree with 3 years of related work experience in healthcare revenue integrity or revenue cycle. Required Experience Qualifications * 5-7 years Healthcare revenue integrity or revenue cycle experience Required * 3-5 years Leadership experience Required * 3-5 years Experience with EPIC clinic or hospital billing systems Preferred Skills and Abilities * Knowledge of Revenue Cycle, Coding, and Charge Capture. Strong understanding of charge capture workflows, CPT/HCPCS, ICD-10, modifiers, documentation requirements, and payer billing rules. * Regulatory & Compliance Knowledge. In-depth knowledge of CMS, Medicare/Medicaid, NCCI edits, payer guidelines, pricing regulations, and the ability to apply regulatory updates to internal processes. * Data Analysis & Reporting Skills. Proficiency using EPIC reporting tools and other analytics platforms to extract, analyze, and interpret charge data, denial trends, and financial impact models. * Charge Description Master (CDM) & Pricing Expertise. Ability to maintain and optimize the CDM, evaluate charging accuracy, review payer contracts, and support retail and service line pricing strategies. * Audit & Problem-Solving Skills. Skilled in conducting charge audits, identifying discrepancies, determining root causes, and recommending corrective actions or workflow enhancements. * Cross-Functional Collaboration & Communication. Ability to work effectively with coding, billing, clinical, and operational teams, communicating complex coding, billing, and revenue integrity concepts clearly. * Project & Process Improvement Abilities. Ability to lead projects, manage competing priorities, implement corrective action plans, and support continuous improvement initiatives across departments. * Attention to Detail & Documentation Skills. Strong accuracy and documentation abilities to maintain audit records, track trends, ensure compliance evidence, and support training and reporting needs. Licenses and Certifications * One or more of the following credentials: American Health Information Management Association (AHIMA), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician Based (CCS-P), Certified Coding Associate (CCA), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), American Academy of Professional Coders (AAPC), National Association of Healthcare Revenue Integrity (NAHRI), or Certification in Healthcare Registry (CHRI) Upon Hire Required * (CHRI) Preferred * EPIC PB Certification Preferred Physical Demands * Sit - Frequently * Stand - Occasionally * Walk - Occasionally * Drive - Rarely * Climb (Stairs/Ladders) - Rarely * Bend (Neck) - Frequently * Gross Manipulation (Hands/Arms) - Constantly * Squat - Rarely * Kneel/Crawl - Rarely * Twist/Turn (Neck) - Occasionally * Twist/Turn(Waist) - Occasionally * Lift/Carry 0-10 lbs. - Rarely * Lift/Carry 11-25 lbs. - Rarely * Lift/Carry 26-35 lbs. - Rarely * Lift/Carry 36-50 lbs. - Rarely * Push/Pull up to 10 lbs. - Rarely * Push/Pull 11-25 lbs. - Rarely * Push/Pull 26-35 lbs. - Rarely * Push/Pull 36-50 lbs. - Rarely * Reach (Above shoulder level) - Rarely * Reach (Below shoulder level) - Constantly * Simple Grasping (Hands/Arms) - Constantly * Fine Manipulation (Hands/Arms) - Constantly * Gross Manipulation (Hands/Arms) - Constantly Working Conditions * Noise - Occasionally Travel Requirements * 5% Hearing Requirements * Hears Whispers < 3 feet - Constantly * Hears Whispers 3-8 feet - Constantly Vision Requirements * Color Discrimination - Constantly * Near Vision (Correctable to Jaeger 2 or 20/40 binocular) - Constantly * Distance Vision (Correctable to Snellen chart 20/40 binocular) - Constantly Prevea is an Equal Employment Opportunity/Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify

Responsibilities

The Revenue Integrity Manager will lead the revenue integrity function and manage the revenue integrity team, focusing on optimizing revenue through accurate charge capture and billing practices. Responsibilities include data analysis, managing chart reviews, monitoring compliance, and collaborating with various teams to resolve issues.