Revenue Integrity Analyst

Summary/Objective
Under general supervision the Revenue Integrity Specialist is the operating muscle of the charge capture engine. Day to day this individual reviews charge tickets (both paper scanned and electronic feeds from EHR) against clinical documentation applies Omega charge capture guidelines to validate or correct the charge reconciles charges to encounters surfaces missed charges and supports the dashboarding effort by feeding clean categorized exception data upstream. The Specialist works across hospital and physician charging contexts with a working understanding of CPT HCPCS ICD-10-CM modifiers revenue codes and place of service implications.

Essential Job Functions

• Review papercharge tickets electroniccharge tickets (e-superbills) and EHR-driven charge feeds for completeness accuracy and adherence to charge capture guidelines.

• Maintain a clear auditable documentation trail in the workflow tool drafting exception notes to defend NCCI (PTP/MUE) and OCE modifier decisions for external auditor review.

• ValidateCPT / HCPCS code selection against documentation; verify modifier appropriateness (25 26/TC 50 51 59 / XEPSU 76/77 91 95 AS / AA / QX / QY / QK GA / GY / GZ).

• Flag missing ormis-applied units incorrect revenue codes place-of-service mismatches and date-of-service inconsistencies.

• Reconciledaily charge files against scheduled / completed encounters from EHR (Epic / Cerner / Meditech) every encounter must have either a posted charge a documented exception or a defensible no-charge reason.

• Investigatevariances within agreed turnaround time; raise tickets for system-level issues (interface failures charge router rule gaps incorrect EAP linkage).

• ApplyCMS NCCI and client specific charge capture guidelines including modifier driven bypass logic and outpatient OCE edits.

• Identifysystemic charge capture defects (e.g. recurring infusion start/stop time gaps recurring Mod 25 misuse on E/M with procedure) and escalate root cause to Lead with sample evidence.

• Categorizeexceptions denials-prevention findings and missed charge recoveries using the standard taxonomy so revenue-integrity dashboards remain consistent across pods.

• Producedaily / weekly individual productivity and accuracy reports; participate in calibration sessions led by QA.

• Operate withinHIPAA HITRUST and Omega information security policy; never share PHI outside designated channels.

• Cooperate withinternal QA audits (sample-based IQ/EQ) and respond to audit feedback with documented corrective action.

Key Success Indicators/Attributes

• Detail oriented under volume pressure comfortable with repetitive review work without losing accuracy.

• Coachability willing to absorb feedback from QA without defensiveness; uses calibration sessions to improve.

• Crisp written communication exception notes are read by US revenue integrity managers; clarity matters more than length.

• Time discipline meets daily TAT; flags blockers early rather than at end of shift.

• Confidentiality and ethical handling of PHI.

• Maintain courteous and professional working relationships with employees at all levels of the organization.

Supervisory Responsibility

No

Work Environment

This job operates in a remote home office environment. This role routinely uses standard office equipment suchas computers and soft phones.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job the employee is occasionally required to stand; walk; sit; use hands to finger handle or feel objects tools or controls; reach with hands and arms; balance; stoop kneel crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision distance vision peripheral vision depth perception and the ability to adjust focus.

Position Type/Expected Hours of Work

This is a full-time position. Each employees schedule must be between the hours of 6:00 AM PST to 9 PM PST Monday through Friday with the specific schedule for each employee to be agreed upon by the employees manager and the employee taking into account the needs of the client. This position occasionally requires long hours and weekend work.

Travel

None

Required Education and Experience

• 3 years hands-on US revenue integrity charge capture or charge audit experience in a US healthcare provider or vendor environment.

• Bachelors degree or combination of relevant experience with strong RCM tenure.

• Hands-on proficiency with at least one major EHR platform: EPIC (Resolute HB/PB) Cerner Patient Accounting Meditech (Magic/Expanse) or Athena.

• Must fulfill one of the following qualifications: Pathway A Active AAPC (CPC/COC) or AHIMA (CCS/CCS-P) certification. Pathway B HFMA CRCR certification paired with at least 4 years of demonstrable depth in charge-capture chargemaster or charge-router operations.

• Working knowledge of payer guidelines and contracts including experience in contract review negotiations or audit variance review across multiple payers.

• Intermediate Excel proficiency including pivot tables lookups conditional formatting and basic formulas.

Preferred Education and Experience

• Familiarity with HFMA MAP metrics (e.g. % missing charges charge lag).

• Ability to read and interpret Power BI or Tableau dashboards to track exception data.

• Prior exposure to multi-hospital or Integrated Delivery Network (IDN) environments where charging rules vary by entity.

• Exposure to charge router rule design (EPIC CRD) charge capture solutions like 3M/MModal/ Optum (formerly OptumInsight) charge capture intelligence.

• AAPC CPMA certification preferred.

Additional Eligibility Qualifications

N/A

Security Access Requirements

In addition to the specific security access required by the employees client engagement the employee will have access to the Omega set forth in the Standard Field Employee profile.

Equal Employment Opportunity:

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race color religion national origin gender age sexual orientation gender identity or expression marital status mental or physical disability protected veteran status and genetic information or any other basis protected by applicable law. Omega Healthcarealso prohibits harassment of applicants or employees based on any of these protected categories.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application interview or any other part of the hiring process please contact Human Resources at.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee for this job. Duties responsibilities and activities may change at any time with or without notice.Employee may perform other duties as assigned.

Required Education and Experience

• 3 years hands-on US revenue integrity charge capture or charge audit experience in a US healthcare provider or vendor environment.

• Bachelors degree or combination of relevant experience with strong RCM tenure.

• Hands-on proficiency with at least one major EHR platform: EPIC (Resolute HB/PB) Cerner Patient Accounting Meditech (Magic/Expanse) or Athena.

• Must fulfill one of the following qualifications: Pathway A Active AAPC (CPC/COC) or AHIMA (CCS/CCS-P) certification. Pathway B HFMA CRCR certification paired with at least 4 years of demonstrable depth in charge-capture chargemaster or charge-router operations.

• Working knowledge of payer guidelines and contracts including experience in contract review negotiations or audit variance review across multiple payers.

• Intermediate Excel proficiency including pivot tables lookups conditional formatting and basic formulas.

Preferred Education and Experience

• Familiarity with HFMA MAP metrics (e.g. % missing charges charge lag).

• Ability to read and interpret Power BI or Tableau dashboards to track exception data.

• Prior exposure to multi-hospital or Integrated Delivery Network (IDN) environments where charging rules vary by entity.

• Exposure to charge router rule design (EPIC CRD) charge capture solutions like 3M/MModal/ Optum (formerly OptumInsight) charge capture intelligence.

AAPC CPMA certification preferred.