Revenue Integrity Specialist

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.

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