Senior Revenue Integrity Analyst - Charge Optimization

Key Responsibilities:

• Lead EPIC (HB/PB) charge build, including CPT/HCPCS, revenue codes, modifiers, pricing, GL mapping, router rules, and testing for new or expanded services

• Maintain and govern the chargemaster through regulatory updates, CDM standardization, defensible pricing, and price transparency accuracy

• Partner with IT and Clinical Informatics to ensure compliant and optimized charge setup

• Establish and monitor charge reconciliation controls, policies, education, variance investigation, and escalation of financial risk

• Promote alignment with Epic Foundation principles and Epic Gold Standard workflows

• Oversee charge capture performance, monitoring charge lag, work queues, and root causes of missed or incorrect charges

• Implement systemic corrections to prevent recurring issues

• Conduct denial root cause analysis, monitor payer edits, and implement build and workflow corrections in partnership with operational, IT, and Revenue Cycle leaders

• Develop and maintain revenue integrity dashboards, KPIs, and reports to help inform and guide leadership actions

• Serve as escalation point for complex issues and mentor Revenue Integrity team members while leading cross-functional optimization initiatives

Education Requirements:

• Bachelor’s degree in a related field

• Extensive relevant experience may be considered in lieu of formal education.

Required Qualifications:

• Epic Resolute (HB and/or PB) experience

• 5+ years in Revenue Integrity, CDM Build/Maintenance, Revenue Cycle, Coding, or healthcare finance

• Advanced knowledge of CPT/HCPCS, revenue codes, CMS billing regulations, charge build workflows and CDM governance

• Strong proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook), including advanced Excel skills for data analysis and reporting

Preferred Qualifications:

• Epic HB or PB certification

• CRCR, CHRI, CPC, CCS, RHIA, RHIT or similar certification

• Experience leading charge standardization initiatives in an integrated health system

• Knowledge of payer contracts and reimbursement methodologies