Revenue Integrity Analyst

Revenue Integrity Analyst-23467 at Rush University Medical Center

Location:

Chicago, Illinois
Work Type:
Full Time (Total FTE between 0.9 and 1.0)

Shift: Shift 1

Work Schedule:

8 Hr (8:00 AM - 4:30 PM)
Pay Range: $27.47 - $43.27 per hour

Summary
The Revenue Integrity Analyst uses advanced knowledge of coding, CDM, charge capture, and auditing to solve complex charging scenarios, provide education and assistance to operational departments, support fellow team members, and develop processes/procedures to ensure accurate and timely capture of all chargeable procedures. The analyst also provides high‑level professional support in working advanced outpatient coding edits and auditing charges for service lines with potential missed revenue opportunities.

Seniority level
:
Entry level
Business Unit:
Rush Medical Center
Hospital:
Rush University Medical Center
Department:
Revenue Cycle Revenue Integrity

• Use logic‑based critical thinking and decision making to accurately enter charges on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines.
• Responsible for accounts within the assigned Epic Account, Charge Review, and Claim Edit Work queues while solving edits related to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits), Procedure to Procedure (PTP edits), and Outpatient Coding Edits (OCE edits) in Epic using patient documentation, coding rules, billing guidelines, and proper modifier use in a timely manner.
• Assess the Charge Description Master (CDM) and contribute to accurate CDM line items by evaluating revenue codes, descriptions, CPT/HCPCS code and pricing.
• Audit and reconcile charges against clinical documentation, code rules, and charging methodologies for internal purposes along with external audits.
• Work with external vendors to review charge capture opportunities and documentation to identify missed charges and correct accounts.
• Identify trends, analyze and propose and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed charges.
• Serve as subject matter expert for team members to review questions and assist with resolving accounts.
• Meet or exceed accuracy, quality, work, on‑time delivery, and productivity standards set by CMS, OIG, and direct manager.
• Research current and future complex payer requirements for compliant billing, timely payment, and maximum reimbursement.
• Provide input and implement process improvement initiatives recognizing revenue enhancement and charge integrity opportunities.
• Communicate, observe, and report on charge entry trends and patterns and provide recommendations for improvement.
• Engage in continual education and training in the revenue integrity field and healthcare CDM, charges, auditing, data, and other duties or projects as assigned.

• Associate’s degree or higher.
• Minimum 2‑4 years of healthcare experience working with billing, charge entry, charge capture, or CDM.
• AAPC Certification, AHIMA Certification, or Epic Software Certification.
• Proficient and functional knowledge of reviewing charges in the Epic EHR.
• Advanced knowledge of medical terminology and medical billing language; thorough knowledge of UB‑04 Revenue Codes, CPT, and HCPCS Level II with modifiers.
• Excellent written and oral communication skills and problem‑solving ability.
• Proficiency with MS Office Suite.
• High degree of accuracy and ability to collaborate with others.

Disclaimer:
The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.

Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.