Revenue Integrity Analyst

Job not on LinkedIn

🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $75 - $90 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 3%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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The Wilshire Group

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💼 Consulting

Healthcare • Healthcare Insurance • Consulting

The Wilshire Group is a consultancy firm that specializes in optimizing revenue cycle operations and IT solutions for the healthcare industry. They provide services in patient access, health information management, revenue integrity, and billing for both hospital and professional settings. The firm focuses on enhancing financial experiences by partnering with clients to solve complex challenges at the intersection of operations and technology. The Wilshire Group is dedicated to helping organizations maximize their EHR investments and improve revenue recognition and workflow optimization, ensuring consistent and proven results.

📋 Description

• Serve as a Revenue Integrity resource for assigned clinical service lines and partner with physicians, clinical, operational, finance, compliance, coding, patient access, HIM, IT, and revenue cycle stakeholders • Review the relationship between the chargemaster (CDM), clinical workflows, Epic configuration, charge capture logic, and downstream billing processes • Maintain Epic chargemaster content within assigned areas and apply knowledge of charge capture, charge router logic, billing workflows, reimbursement, Epic revenue cycle functionality, and charging functionality within related Epic clinical modules • Perform end-to-end assessments of scheduling, documentation, charge capture, billing, reimbursement, and payment workflows to identify opportunities for improvement • Identify root causes of missed, inaccurate, or incomplete charges and recommend and implement corrective actions • Work with business and technical teams to improve workflows, system configuration, documentation, and charge capture processes, including increasing automation when possible • Analyze operational, financial, and utilization data to identify trends, charging variances, underpayments, missed revenue, and other revenue optimization opportunities • Monitor implemented changes and measure results to confirm improvements are working as intended • Support or lead Revenue Integrity assessments for new clinical programs, technologies, procedures, and service lines • Maintain knowledge of federal and state regulations, payer requirements, CPT, HCPCS, ICD-10-CM/PCS, NCCI, Medicare guidance, and revenue cycle best practices • Provide guidance to other analysts as needed; more senior candidates may serve as a subject matter expert or mentor on complex revenue integrity issues

🎯 Requirements

• Advanced knowledge of hospital and professional revenue cycle operations, including revenue integrity, charge capture, coding, billing, and reimbursement • Strong Epic revenue cycle experience, including chargemaster/CDM management, charge router functionality, charging workflows, and workflow optimization • Ability to evaluate clinical and revenue cycle workflows across multiple service lines and turn findings into practical recommendations • Strong analytical, critical-thinking, and problem-solving skills, including the ability to identify root causes and assess financial impact • Ability to independently manage priorities and work effectively with cross-functional teams in a remote environment • Strong communication and relationship-building skills with the ability to explain revenue cycle and technical concepts to operational leaders and stakeholders • Bachelor's degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or a related field, or an equivalent combination of education and experience • Progressive Revenue Integrity experience, including service line assessments, revenue optimization, and cross-functional initiatives • Epic Revenue Integrity/Chargemaster certification or demonstrated Epic Revenue Cycle experience preferred • Revenue integrity, coding, or revenue cycle certification preferred (CPC, COC, CCS, CHRI, CRCR, or equivalent) • Clinical experience or clinical education/credentials, such as RN or another relevant clinical background, is a plus for senior-level candidates