Job Role Description

Accounting > Health Information Revenue Integrity Analyst

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Short Description:

A Health Information Revenue Integrity Analyst is responsible for reviewing and analyzing healthcare data to ensure accurate coding, billing, and reimbursement processes. They identify discrepancies, investigate claims, and collaborate with coding, billing, and clinical teams to resolve issues and optimize revenue. The role involves maintaining compliance with regulatory standards, preparing reports, and supporting audits or quality improvement initiatives. Revenue Integrity Analysts help maximize financial performance while ensuring accurate and compliant health information management. Strong analytical, problem-solving, and attention-to-detail skills are essential for success in this role.

Duties / Responsibilities:

  • Review and analyze patient medical records and billing data to ensure accurate coding and proper reimbursement
  • Identify and resolve discrepancies, inconsistencies, or errors in clinical documentation and charge capture
  • Collaborate with coding, billing, and clinical teams to ensure compliance with regulatory and payer requirements
  • Monitor revenue integrity metrics and trends to detect potential risks or lost revenue opportunities
  • Prepare reports and summaries on audit findings, corrective actions, and revenue recovery efforts
  • Assist in the development and implementation of policies, procedures, and best practices to maintain revenue accuracy
  • Support internal audits, compliance reviews, and payer audits related to documentation and billing processes
  • Provide guidance and training to clinical and administrative staff on proper documentation and coding practices
  • Track and follow up on outstanding documentation issues or corrective actions to closure
  • Stay current on healthcare regulations, coding guidelines, and payer policies to optimize revenue integrity

Skills / Requirements / Qualifications

  • Education: Associate’s or Bachelor’s degree in Health Information Management, Healthcare Administration, or related field preferred
  • Experience: 2–4 years of experience in medical coding, revenue cycle, or health information management
  • Technical Skills: Proficiency in electronic health records (EHR), coding software, and billing systems
  • Analytical Skills: Ability to review complex medical documentation, identify discrepancies, and implement corrective actions
  • Attention to Detail: Accuracy in coding, documentation review, and reporting
  • Regulatory Knowledge: Understanding of HIPAA, ICD-10, CPT, and other healthcare regulations and coding standards
  • Communication: Strong verbal and written communication skills for interacting with clinical staff, coders, and management
  • Problem-Solving: Ability to investigate revenue discrepancies, resolve issues, and recommend process improvements

Job Zones

  • Title: Job Zone Four: Considerable Preparation Needed
  • Education: Most of these occupations require a four-year bachelor's degree, but some do not. 
  • Related Experience: A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. 
  • Job Training: Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.
  • Job Zone Examples: Many of these occupations involve coordinating, supervising, managing, or training others. 
  • Specific Vocational Preparation in years: 2-4 years preparation (7.0 to < 8.0)

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