SENIOR REVENUE INTEGRITY ANALYST FT
hace 24 días
Plano
Job Description About Legent Health At Legent Health, our mission is simple yet profound: “To provide first-class health care that puts YOU first.” Our vision reflects our commitment to excellence: “Through robust physician partnerships, become a nationwide leader in compassionate, quality healthcare focused on the patient and available to everyone.” Our values, also known as our brand pillars, define how we stay true to our identity in the healthcare industry and the communities we serve. These values are central to everything we do: • Respect: We honor the time and trust of both patients and physicians by delivering organized, efficient services that ensure a seamless healthcare experience., • Service: We are committed to highly personalized care for patients, their families, and the physicians who serve them, driving optimal outcomes for all., • Leadership: We strive to be a trusted leader through innovation, clear communication, and unwavering dedication to excellence across our employees and partners. Joining Legent Health means being part of a team that lives these principles every day, as we build a future focused on compassionate, quality care. About the Role The Senior Revenue Integrity Analyst is a high-impact individual contributor responsible for ensuring the completeness and accuracy of revenue across Legent Health’s surgical hospitals and ambulatory surgery centers. This role spans the entire revenue cycle—from pre-operative charge capture validation through payment variance resolution—and serves as the analytical bridge between revenue cycle operations and the revenue accountant. The Senior Analyst identifies systemic revenue leakage, validates expected reimbursement against payer contracts and fee schedules, investigates underpayments and overpayments, and drives cross-functional process improvements that produce measurable financial results. This is not an accounting role; it is an operationally focused position that ensures every dollar earned in the operating room is accurately captured, correctly billed, properly reimbursed, and reliably reconciled. POSITION’S ESSENTIAL RESPONSIBILITIES: Front-End Revenue Integrity & Charge Capture • Perform daily charge-to-schedule reconciliation across all surgical facilities, comparing the operative schedule against posted charges to identify missing or incomplete items., • Own the chargemaster (CDM) for accuracy and compliance, including adding, modifying, and deactivating charge codes, validating CPT/HCPCS and revenue code assignments, and coordinating annual pricing updates aligned with budgetary and managed care contract requirements., • Reconcile implant, device, and supply charges against operative reports, vendor invoices, and physician preference cards for high-acuity surgical specialties (spine, orthopedic, cardiac, bariatric)., • Audit charge capture completeness for both hard-coded and soft-coded items, with particular focus on commonly missed add-on codes, bilateral modifiers, and segmental instrumentation charges., • Partner with OR staff, materials management, and surgical services leadership to close documentation and charge capture gaps at the point of service. Mid-Cycle Validation & Contract Compliance • Model expected reimbursement at the CPT and line-item level using payer calculators and the contract management tool, comparing expected versus actual allowed amounts for each case., • Monitor payer-specific rules, bundling logic, and implant authorization thresholds to proactively flag claims at risk of underpayment or denial before submission., • Produce payer performance scorecards identifying contracts that are systematically underpaying, overpaying, or deviating from contractual terms, and support the managed care team with data for renegotiations., • Validate that contractual adjustments, write-offs, and allowances are calculated correctly and consistently across all facilities. Back-End Valiance Analysis & Reconciliation • Analyze payment variances—both underpayments and overpayments—against expected reimbursement, quantifying impact by payer, service line, facility, and procedure type., • Investigate denial root causes by payer and category, track trends over time, and drive corrective action upstream to prevent recurrence., • Work closely with the revenue accountant to reconcile recorded revenue against expected and actual payments, ensuring the integrity and accuracy of financial reporting., • Monitor AR aging, late charges, DNFB, and days-to-bill metrics, escalating anomalies and providing root cause analysis., • Identify and quantify revenue at risk from payer audit activity, retroactive payment adjustments, and post-payment recoveries. Process Improvement & Cross-functional Collaboration • Identify root causes of revenue leakage—broken charge routing rules, outdated CDM items, missing preference card updates, training gaps—and implement permanent, systemic fixes., • Build and maintain repeatable revenue integrity playbooks that can be deployed across new facility acquisitions and integrations., • Collaborate cross-functionally with verification of benefits and authorization teams, coding, billing, clinical documentation, and facility operations to resolve issues and standardize processes., • Develop and present dashboards, KPI reports, and executive-level summaries for revenue cycle leadership and governance committees., • Evaluate and support the implementation of AI-powered and automation tools for charge capture, predictive denial prevention, and contract compliance, serving as the subject matter expert who validates tool performance., • Lead or participate in revenue integrity governance meetings, providing data-driven recommendations that connect operational improvements to EBITDA impact. EDUCATION AND EXPERIENCE REQUIREMENTS: • Bachelor’s degree in health administration, health information management, finance, business, or a related field., • Minimum 3–5 years of progressive experience in healthcare revenue cycle operations, with direct involvement in at least two of the following: charge capture, chargemaster management, coding, revenue integrity, contract underpayment analysis, or payment variance resolution., • Demonstrated experience in a hospital or ASC setting, preferably surgical., • CHRI (Certification in Healthcare Revenue Integrity) – NAHRI, (preferred), • CRIP (Certified Revenue Integrity Professional) – AAHAM, (preferred), • CPC (Certified Professional Coder) – AAPC or CCS (Certified Coding Specialist) – AHIMA, (preferred), • CRCR (Certified Revenue Cycle Representative) – HFMA, (preferred), • Strong working knowledge of CPT, HCPCS, ICD-10-CM/PCS, revenue codes, NCCI edits, and Medicare reimbursement methodologies (DRG, APC, ASC groupers)., • Proficiency in at least one major hospital EHR/practice management system., • Advanced Excel skills (pivot tables, VLOOKUP/INDEX-MATCH, data modeling) and experience with data visualization tools (Power BI, Tableau, or equivalent)., • Ability to work cross-functionally with clinical, operational, and financial stakeholders without positional authority., • Strong analytical and problem-solving skills, with the ability to move from data to root cause to systemic fix., • Experience in a multi-facility or PE-backed healthcare platform environment., • Direct experience with surgical billing for high-acuity specialties (spine, orthopedic, cardiac, bariatric), including implant charge processes and bill-only workflows., • Familiarity with contract management and payer modeling tools., • SQL or equivalent query capability for ad hoc data analysis., • Experience evaluating or managing AI/automation tools within revenue cycle operations. Why Join Legent Health? Legent Health fosters an environment where team members are empowered to deliver exceptional care while growing professionally within a supportive, values-driven culture. We Offer: • Competitive salary and performance incentives, • Comprehensive benefits package, • Paid time off and wellness programs, • Career development and training opportunities Equal Employment Opportunity (EEO) Statement Legent Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, disability status, or any other legally protected characteristic. I-9 and E-Verify Compliance: Employment eligibility will be verified through the U.S. Department of Homeland Security’s E-Verify system. All applicants must provide valid documentation to establish identity and authorization to work in the United States, as required by federal law.
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