Revenue Integrity Analyst

• DEFINITION/PRIMARY FUNCTIONS

  • The Revenue Integrity Analyst is responsible for identifying, analyzing, and resolving reimbursement variances to ensure Berkshire Health Systems receives accurate payment in accordance with payer contracts, fee schedules, and applicable regulatory requirements. The position primarily utilizes reimbursement analytics tools to compare expected versus actual payments, identify payer underpayments, investigate payment discrepancies, support appeals and recovery efforts, and monitor payer compliance with contractual reimbursement terms. Working collaboratively and supporting Revenue Cycle, Patient Financial Services, Payor Contracting, Information Technology, and operational leaders, this role evaluates reimbursement trends, determines root causes of payment variances, assists with contract modeling and system validation, and recommends process improvements that strengthen payment accuracy and net revenue. Knowledge of Medicare, Medicaid, and commercial payer reimbursement methodologies, hospital billing practices, and contract interpretation is important to the role. Charge capture, coding, documentation, and denial analysis may be performed as needed to support reimbursement investigations and payment recovery.

• POSITION QUALIFICATIONS (Minimum qualifications are required unless stated otherwise.)

  • Experience:

    • 3 years experience in healthcare reimbursement, revenue cycle, contract management, payment integrity, or a related analyst role.
    • Knowledge of inpatient and outpatient hospital reimbursement, payer contracts, payment methodologies, and Medicare, Medicaid, and commercial reimbursement practices required .
    • Strong quantitative, analytical and organizational skills required.
    • Experience with contract management/reimbursement analytics systems strongly preferred.
    • Experience with Expanse and/or Meditech software, preferred.
    • Evidence of strong computer skills required.

  • Education and Training:

    • BA degree required in Business Administration, Finance, Accounting, or a closely related field.

  • License, Certification & Registration:

    • None.

  • Other Requirements:

    • Exceptional communication skills, both written and verbal, and interpersonal relationship skills are required.
    • Advanced experience with Microsoft Office, especially Excel, Word and Outlook.
    • Establishes and maintains effective relationships.
    • Ability to handle stressful situations calmly and rationally and work under deadline pressures.
    • Willing to accept additional responsibilities/duties as position requires.
    • Must be self-motivated and able to work with autonomy, possessing skills in problem solving.
    • Demonstrates and promotes a culture of continuous improvement.
    • Demonstrates experience working in a team-oriented, collaborative environment.

Location: Berkshire Health Systems · BMS Reimbursement
Schedule: Full Time, Shift 1, 8:00am-4:30pm