Revenue Integrity Specialist

Job Description:

We are seeking a detail-oriented Revenue Integrity Analyst to support healthcare revenue cycle operations by ensuring accurate coding, charge capture, reimbursement optimization, and compliance with regulatory guidelines. The candidate will perform coding validations, charge audits, reimbursement trend analysis, CDM maintenance, and revenue integrity reviews to identify potential revenue leakage and improve financial performance.

Key Responsibilities

• Review patient accounts to validate diagnosis, procedure, and modifier coding accuracy against medical record documentation and coding guidelines.
• Identify coding discrepancies and escalate errors to coding teams for correction.
• Perform revenue integrity audits and report coding accuracy findings to internal stakeholders.
• Analyze coding and reimbursement performance metrics, including:
• Case Mix Index (CMI)
• DRG distribution trends
• CC/MCC utilization
• Denial trends and reimbursement variances
• Generate analytical reports and provide recommendations for revenue optimization.
• Conduct charge capture reconciliation by comparing scheduled services with charges posted in the billing system.
• Identify and escalate missing, delayed, or inaccurate charges.
• Validate charge tickets against documented patient services to ensure complete and accurate billing.
• Maintain and update Charge Description Master (CDM) revenue code assignments.
• Support implementation of new charge items and chargemaster updates following approved requests.
• Recommend process improvements, charging methodologies, and internal controls to promote consistent charging practices across facilities.
• Collaborate with Coding, CDI, Revenue Cycle, Finance, and Operations teams to minimize revenue leakage and enhance compliance.
• Ensure adherence to CMS, payer-specific, and organizational revenue integrity standards.

Work Location: Navi Mumbai(Onsite)

Interested Candidates can Contact: [phone removed], [phone removed]