Revenue Integrity Charge Review Analyst (Finance)

The Revenue Integrity Charge Review Analyst is responsible for reviewing and analyzing hospital and/or professional charges to ensure accurate, complete, and compliant charge capture across all hospital revenue generating departments. Monitors daily charge reports to identify any potential charging issue related to system failures, system updates or others. Reviews denial trends for documentation and charging opportunities. Serves as a liaison between Administration, Revenue Cycle Teams, and ancillary department directors or managers regarding total charge variations and revenue opportunities. This role supports revenue cycle operations by identifying billing issues, preventing revenue leakage, and ensuring that coding and documentation align with payer requirements, regulatory guidelines, and internal policies.
Essential Functions:
Work closely with Chief Financial Officer and Director of Revenue CycleAssist CFO and Director of Revenue Cycle to develop tools and reports to track and identify potential areas of lost revenues.Review clinical documentation and charge data to verify accurate charge capture across service lines.Audit and analyze charge transactions for completeness, appropriateness, and compliance with regulatory and payer requirements (e.g., CMS, Medicare/Medicaid, commercial payers).Identify and correct charging discrepancies or missing charges through daily charge reconciliation and exception reporting.Analyze denial trends related to charge capture and billing; collaborate with coding, billing, and clinical teams to identify root causes and implement corrective actions.Collaborate with clinical departments, coders, billing teams, and IT to resolve charge-related issues and improve processes.Support and facilitate the annual charge description (CDM) pricing review in alignment with finance and reimbursement.Drive communication of CDM changes to impacted clinical departments.Provide feedback and education to departments regarding charging practices and documentation improvements.Monitor and interpret updates to billing guidelines, CPT/HCPCS codes, and regulatory changes to ensure compliance.Review charges in CPT, HCPCS, and revenue codes for accuracy, compliance, and with applicable billing guidelines and optimization of reimbursement. This may include, but not be limited to, billing edits, clearinghouse rules, and opportunities for automation.Take an active role in Revenue Cycle Action Team (RCAT) meetingsAssist in developing, testing, and maintaining charge capture tools, charge master updates, and audit mechanisms.Participate in revenue integrity initiatives, system implementations, and process improvement projects.Maintain documentation of audit findings, trends, and resolutions to support compliance and training efforts.Performs other duties and responsibilities as assigned.

Minimum Qualifications:
Bachelors degree in Healthcare Administration, Health Information Management, Nursing, Finance, or a related field (required).CRIP, CCS, CPC, RHIA, RHIT or similar credential a plus.
At least 35 years of experience in healthcare revenue cycle, charge capture, coding, billing, or compliance.Strong knowledge of hospital or professional billing and coding guidelines (CPT, HCPCS, ICD-10, UB-04/1500 forms).Experience with managing and resolving coding-related billing editsFamiliarity with Cerner EHR systems and revenue cycle systems.
Detail-oriented with strong analytical and critical thinking skills is a must.Ability to work independently and manage multiple priorities.Strong interpersonal and communication skills for collaborating effectively with various departments.Effective communication and collaboration skills with clinical and administrative teams by interpreting complex financial data to diverse audiences, including leaders and clinical staffProficiency in Technology and data analysis, data mining, audit software, and reporting tools, including Microsoft Excel

Working Conditions
This position is typically office-based but may require occasional visits to patient care areas.
Occasional evening or weekend hours may be required to meet operational needs, including audits, training, or regulatory compliance deadlines.
As a Critical Access Hospital, the HIM Manager may be expected to handle a variety of tasks with limited administrative support and to work closely with a small, tight-knit team.
Company Specific
Represents Excelsior Springs Hospital with professionalism by adhering to our SERVICE values and upholding hospital policies.
v SERVICE: Supportive, Engaged, Respectful, Vibrancy, Integrity, Communication, and Excellence
Protects PHI and HIPAA sensitive information for all patients and staff.Provides excellent care by ensuring all licensure, certification and hospital specific compliance training standards are met or exceeded.Consistently follows departmental and hospital Health, Safety, Security, Hazardous Materials policies, and best practices.