Revenue Integrity Specialist

Responsibilities

• Prepares Excel analysis, including V-Lookups and pivot tables. Gathers and compiles data in a systematic fashion, clearly documenting assumptions, and validating accuracy of information to resolve inconsistencies.
• Evaluate and implement charge requests with appropriate CPT/HCPCS codes, revenue codes, and pricing, ensuring alignment with clinical services and coding/billing guidelines.
• Conducts Charge Capture Audits: Review and analyze patient records, billing data, and financial statements to ensure charge and coding compliance. Identify discrepancies or errors and develop action plan for future state resolution
• Analyzes data to identify likely relationships, summarizes data and prepares summary materials for discussion with clinical and finance teams.
• Monitor regulatory changes and payer updates that may impact charge master and revenue integrity.
• Collaborates with various departments to resolve CDM or RI discrepancies (Utilization Management (UM), Clinical Documentation Integrity (CDI), RCM, Coding Services, Clinical Departments, and Health Information Management (HIM)).
• Serve as a liaison during system upgrades, new service implementation, and pricing reviews.
• Responsibilities and experience required in the following:
• Maintain and update the Charge Description Master (CDM)
• Sox Control regulations
• Ensure charges comply with:
• CMS (Medicare OPPS/IPPS) rules
• NCCI edits
• Local Coverage Determinations (LCDs) / NCDs
• Payer-specific billing requirements
• Validate correct assignment of:
• HCPCS/CPT codes
• Modifiers
• Units of service
• Monitor annual/quarterly code updates (e.g., CPT, HCPCS, APC changes)
• Review clinical workflows to ensure all billable services/supplies are captured
• Identify missed revenue opportunities (undercharges, missing charges)
• Partner with departments (Radiology, OR, Cath Lab, etc.) to validate charge practices
• Analyze denials tied to:
• Incorrect HCPCS/CPT
• Missing modifiers
• Bundling/edit issues
• Recommend CDM or workflow fixes to prevent recurrence
• Investigate and resolve:
• Charge errors
• Denials related to coding or CDM setup

Requirements

• 3+ years coding experience
• Hospital coding experience
• Experience with Charge Capture Audits
• CCS, CIRCC, COC, CPC or equivalent preferred
• EPIC experience preferred
• For this US-based position, the base pay range is $48,131.00 - $81,225.49 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.
• This job is eligible to participate in our annual bonus plan at a target of 5.00%
• The healthcare system is always evolving - and it's up to us to use our shared expertise to find new solutions that can keep up. On our growing team you'll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.
• If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact

Benefits

Additional Information

Job Description R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Revenue Integrity Analyst, you play a key role in maintaining the accuracy, compliance, and efficiency of the charge master. You are responsible for conducting in-depth audits, analyzing complex billing issues and supporting departments in ensuring accurate charge capture and reimbursement. To thrive in this role, you must have a coding background.

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