Revenue Integrity Analyst

Summary

Avera Health is a healthcare organization focused on serving patients, families, and communities through compassionate care. The Revenue Integrity Analyst enhances financial performance and reimbursement accuracy by analyzing revenue cycle data, auditing charges and payments, managing denials and appeals, and collaborating with clinical, billing, coding, IT, and payer relations teams.

Responsibilities

• Design, maintain, and enhance dashboards and scorecards for denials, write-offs, payer performance, and charge activity. Analyze trends and translate complex data into actionable insights for stakeholders
• Conduct audits and Revenue Guardian checks to validate charge accuracy and completeness. Perform payer-specific audits and monitor ED Discharge and Charge Tracker Reports
• Monitor and resolve Discharged Not Billed (DNB) accounts to ensure timely claim submission
• Investigate denials and underpayments, identify root causes, and recommend process improvements
• Manage appeals for underpaid claims, track outcomes, and report on recovery efforts and payment trends
• Review high-dollar write-offs for appropriateness and escalate discrepancies as needed
• Oversee Post-Service Single Case Agreements (SCAs) to ensure reimbursement accuracy and adherence to contract terms
• Partner with clinical, operational, and payer relations teams to resolve discrepancies and improve documentation
• Participate in audits, strategic initiatives, and projects aimed at financial optimization and revenue integrity
• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community
• Promote Avera’s values of compassion, hospitality, and stewardship
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity
• Maintain confidentiality
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable

Skills

• Associate's in Healthcare Administration, Finance, Business Analytics, or related field and/or 2-3 years of experience in healthcare revenue cycle analytics, charge auditing, or payment integrity
• Two to three years experience in healthcare revenue cycle analytics, charge auditing, or payment integrity
• Knowledge of healthcare billing, denial management, and/or payer reimbursement methodologies
• Bachelor's
• Certified Revenue Cycle Representative (CRCR) - Healthcare Finance Management Association (HFMA) Upon Hire or
• Certified Specialist Payment & Reimbursement (CSPR) - Healthcare Finance Management Association (HFMA) Upon Hire
• Proficiency in data visualization tools (e.g. Power BI, Tableau) and Excel
• Experience with Epic reporting tools (e.g., SlicerDicer, Reporting Workbench, Clarity, billing and contract modules)

Qualifications

Must Haves

• Associate's in Healthcare Administration, Finance, Business Analytics, or related field and/or 2-3 years of experience in healthcare revenue cycle analytics, charge auditing, or payment integrity
• Two to three years experience in healthcare revenue cycle analytics, charge auditing, or payment integrity
• Knowledge of healthcare billing, denial management, and/or payer reimbursement methodologies

Nice to Haves

• Bachelor's
• Certified Revenue Cycle Representative (CRCR) - Healthcare Finance Management Association (HFMA) Upon Hire or
• Certified Specialist Payment & Reimbursement (CSPR) - Healthcare Finance Management Association (HFMA) Upon Hire
• Proficiency in data visualization tools (e.g. Power BI, Tableau) and Excel
• Experience with Epic reporting tools (e.g., SlicerDicer, Reporting Workbench, Clarity, billing and contract modules)

Benefits

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship