SUMMARY: InterMed's Revenue Cycle Management team supports net patient revenue across a multi-specialty group practice. The Revenue Integrity Analyst is a critical link between clinical documentation, coding, charge capture, payer contracting, and patient financial services. This role ensures that services rendered are accurately captured, coded, billed, and reimbursed in accordance with payer contracts, CMS guidelines, and internal compliance standards — while identifying and resolving root causes of revenue leakage, denials, and underpayments before they recur. Given InterMed's payer mix and its blend of fee-for-service and value-based reimbursement, this role requires fluency across multiple reimbursement methodologies and the ability to prioritize work based on financial materiality and risk.
CORE RESPONSIBILITIES:
- Monitor charge capture accuracy across departments to identify missed, duplicate, or mis-coded charges; quantify and report dollar impact.
- Maintain and audit the Charge Description Master (CDM), ensuring CPT/HCPCS codes, revenue codes, and pricing remain current with annual CMS and AMA updates.
- Partner with coding/compliance staff to resolve recurring documentation-to-charge discrepancies.
- Conduct periodic chart-to-claim audits for high-volume or high-risk service lines.
- Reporting & Analytics
- Build and maintain dashboards/KPIs for leadership. Present findings and recommendations to RCM leadership and, as needed, department chairs/practice managers.
- Support payer contract negotiation cycles with historical utilization and reimbursement data. Support annual revenue budgeting.
- Analyze patient billing accuracy (estimates, statements, adjustments) to reduce billing errors that drive patient complaints, bad debt, or write-offs.
- Collaborate with clinical practice managers on price transparency, estimate accuracy, and self-pay policy compliance.
- Denials & Underpayment Analysis
- Analyze denial trends by payer, provider, and service line to further identify revenue capture opportunities.
- Perform contract yield analysis: compare expected reimbursement (per commercial and Medicare Advantage fee schedules) to actual payments to identify underpayments and variance patterns. Work with accounting department to support the reconciliation of value-based payments/incentive distributions against contract terms and flag discrepancies.
- Maintain deep familiarity with InterMed's payer contract terms, fee schedules, and reimbursement policies.
- Payer & Regulatory Compliance
- Track payer policy changes and ensure billing logic reflects current requirements. Partner with billing leadership to monitor plan-specific prior authorization, coding, and documentation requirements.
- Support internal and external audits with data pulls, documentation review, and corrective action follow-up.
- Maintains strict confidentiality in alignment with HIPAA (Health Insurance Portability and Accountability) guidelines and InterMed policies.
- Perform other duties to support the mission, vision and values of InterMed.
MISSION AND VALUES:
- Follows InterMed’s mission to provide patient-centered primary care, putting the patient first to deliver high quality, high value care.
- Provide the highest quality care to our patients with a level of service that exceeds their expectations.
- Maintain a positive attitude and always treat our patients and each other with dignity and respect.
- Insist on honesty and integrity from each other and our business partners.
- Make teamwork a core component of our relationships between physicians, colleagues, and patients.
- Embrace change to better serve our patients.
- Use business practices that feature individual accountability and group responsibility to ensure delivery of high value healthcare.
- Have fun as we carry out our mission to serve.
KNOWLEDGE, SKILLS, AND ABILITIES:
Education:
- Bachelor's degree in Healthcare Administration, Finance, Accounting, or related field required
License/Certifications:
- Certification such as CRCR (Certified Revenue Cycle Representative), CPC (Certified Professional Coder), or CHRI (Certified in Healthcare Revenue Integrity) preferred
Experience:
- 5+ years of experience in healthcare revenue cycle, revenue integrity, coding/compliance, or payer contracting, ideally within a multi-specialty medical group or ambulatory setting required.
- Working knowledge of CPT, HCPCS, ICD-10-CM, and revenue codes required.
- Understanding of commercial payer, Medicare Advantage, and traditional Medicare (CMS) reimbursement methodologies required.
- Strong proficiency in Excel, and experience with practice management/EHR systems required.
- Familiarity with SQL or BI tools (Power BI, Tableau) for self-service reporting preferred.
- Strong analytical skills with the ability to translate data into actionable operational recommendations.
- Analytical rigor and attention to detail
- Cross-functional collaboration (clinical, coding, IT, finance, patient access)
- Comfort operating across multiple reimbursement models simultaneously
- Clear written and verbal communication for both technical and non-technical audiences
- Project management and follow-through on corrective action plans
The estimated compensation range is the budgeted amount for this position. Final offers are based on various factors, including skill set, experience, location, qualifications, and other job-related reasons. Certain positions may be eligible for incentive compensation plans above and beyond base compensation.