It's no secret that healthcare organizations are struggling to keep up with the ever-changing landscape of coding and billing. Increasingly complex regulations and payer guidelines make it difficult to ensure that claims are filed correctly, leading to lost revenue and frustrated patients. That's where revenue integrity analysts come in.
These specially trained professionals have a unique combination of compliance, coding, and clinical knowledge. They are experts at reviewing claims and identifying errors, which can help your practice recoup lost revenue and improve your bottom line.
But how do you hire a revenue integrity analyst? Keep reading for more details on the role of these analysts and a step-by-step guide to finding and hiring the right person for the job.
What Is a Revenue Integrity Analyst?
A revenue integrity analyst is a professional who helps healthcare organizations identify and correct billing mistakes, overcharges, and underpayments. They also ensure compliance with government regulations and managed care contracts.
Revenue integrity analysts review third-party payment trends and compare payments to expected reimbursement rates. They may also participate in provider training on coding and documentation requirements.
These professionals will work with providers to appeal the decision in the event of denials. They will analyze the trends in denials, determine the root cause, and develop strategies to prevent future denials.
Where To Find Prospective Revenue Integrity Specialists
When hiring a revenue integrity analyst, you can consider various sources for prospective candidates. Below are some examples of places to look.
LinkedIn has over 830 million users spread across more than 200 countries worldwide. With such a broad reach, this platform is a great place to start your search for revenue integrity analysts.
You can use the site's search feature to find potential candidates. For example, you could search for "revenue integrity analyst" or "coding specialist." You can also use LinkedIn's Advanced Search feature to narrow your results by location, industry, and other factors.
Several specialized job boards focus on the healthcare industry. These platforms can be an excellent resource for finding revenue integrity analysts and other medical coding and billing professionals.
Some of the most popular healthcare job boards include:
When searching for revenue integrity analysts on these job boards, use specific keywords and filters to narrow your results. This will help you find candidates who are a good fit for the job.
Can I Hire a Remote Revenue Integrity Specialist?
With the preference for remote work on the rise, you may wonder if hiring a revenue integrity analyst who works remotely is possible. The answer is yes!
Most of the tasks that a revenue integrity specialist performs can be done remotely. This means you can hire someone who lives in another state or country.
According to a recent Forbes survey, 90% of employees are equally or more productive when working remotely than when they spend all day in the office. Not to mention that 68% of U.S. employees prefer working from home at least some of the time. These statistics imply there's a good chance you'll be able to find a revenue integrity analyst who is willing to work remotely.
What To Look For in a Resume of a Revenue Integrity Analyst
When reviewing the resumes of potential revenue integrity analysts, you should know that the best-qualified revenue integrity analysts will have a certification from a recognized organization. Some of the most relevant certifications to consider include the following:
Certificate in Healthcare Revenue Integrity (CHRI)
The National Association of Healthcare Revenue Integrity issues this certification. CHRI holders are proficient in all knowledge areas related to revenue integrity. These include revenue management, internal reporting strategies, rules and regulations, and compliance.
When you hire revenue integrity analysts with this certification, you can be sure they will do well in analyzing the root cause of revenue issues and all practices involving monitoring and auditing.
Certified Professional Coder (CPC)
The American Academy of Professional Coders (AAPC) issues this certification to individuals who demonstrate a deep understanding of medical coding guidelines. CPC holders are experts in coding all medical procedures and services physicians offer. They can expertly code all diagnoses, patient symptoms, and diagnostic tests.
CPC holders are knowledgeable in different coding systems, such as HCPCS Level II supply codes, the ICD-10, and CPT.
When looking at resumes, you should also take note of the core skills that revenue integrity analysts need. These skills include:
Knowledge of Medical Billing Systems and Coding
This skill is vital because revenue integrity analysts need to know how to code medical procedures and services using different coding systems. They should also be familiar with different medical billing systems to submit claims to insurance companies.
Understanding of Payer Contracts and Reimbursement Terms
Revenue integrity analysts need to understand the terms of the contracts between healthcare providers and insurance companies. They should also know about the different reimbursement rates for various procedures. This knowledge is vital in ensuring that healthcare providers receive the correct payments from insurance companies.
Knows How To Identify and Correct Errors in Claim Payments or Denials
It is not uncommon for insurance companies to make errors in claim payments or denials. Revenue integrity analysts need to identify and correct these errors so healthcare providers can get the correct payments. They should also know how to appeal denied claims and submit additional documentation to support the appeal.
Experience in Software Used for Revenue Integrity Analysis
A revenue integrity analyst needs to regularly use software to analyze data to ensure there are no revenue leakages and that every encounter translates into revenue. For the analysis, they will need to use revenue integrity analysis tools like Excel. They must also be proficient in data visualization tools like Qlikview and PowerBI.
If the revenue integrity analyst works in a healthcare setting, they will need to be familiar with EHR software like Epic. This software manages day-to-day operations, such as patient records, appointments, and billing.
Revenue Integrity Analyst Salary — What Is Competitive in 2022?
The average salary for a revenue integrity analyst will vary, mainly depending on an individual's years of experience and the job's location.
Entry-Level Salary Average
According to Glassdoor, the average annual U.S. salary for an entry-level revenue integrity analyst is $52,226. Analysts may earn more through bonuses, commissions, profit-sharing, and tips.
Senior Salary Average
The average annual salary for a senior revenue integrity analyst is $75,431 per year. This salary is for analysts who have over seven years of experience.
Revenue Integrity Analyst Job Description
A revenue integrity analyst ensures that the organization receives accurate reimbursement for its services. They do this by auditing claims, coding medical procedures, and analyzing payer contracts.
- Review trends in third-party payment systems to identify documentation and charging opportunities
- Assist in maintaining and reviewing CDM codes for accuracy
- Develop denial reports
- Establish audit trails to help in investigating adjustments, write-offs, and refunds
- Prepare monthly adjustments and reports and distribute them to relevant clinical areas
- Review claims for accuracy and compliance with payer contracts
- Code medical procedures using correct coding systems
- Analyze payer contracts to ensure proper reimbursement
- Appeal denied claims
- Identify errors in claim payments and denials
Education: Bachelor's degree in business, accounting, finance, or a related field
Licenses and certification: Certified Professional Coder (CPC) or Certificate in Healthcare Revenue Integrity (CHRI)
Experience: Two to five years of experience working with a medical group practice or in a complex healthcare environment
Skills, knowledge, and abilities:
- Analytical and problem-solving skills
- Familiarity with healthcare software, such as Epic
- Proficient in Excel and data visualization tools, such as Qlikview and PowerBI
- Ability to work well with others
- Ability to make the right judgment in complex situations
- Ability to organize details logically
- Excellent communication skills
- Ability to adapt well to changes in work volume and duties
Compensation: A starting annual salary of $58,000
Work environment: A typical office environment with moderate noise levels
Revenue Integrity Analyst Interview Questions
- How familiar are you with data analysis, visualization tools, and healthcare software?
- Can you give an example of a time you had to appeal a denied claim? How was the experience?
- If hired, which areas of revenue integrity would you prioritize and why?
- Are you familiar with the regulations governing revenue integrity analysis?
- How do you handle confidential information about patients and their treatments?
- What is the most important thing to know when auditing claims?
- We want to improve our appeal success rate. Do you have any ideas on how we can do that?
- What do you think is the most crucial factor in ensuring accurate reimbursement?
- What tips do you have for streamlining the claims process?
- Have you ever encountered a situation where you didn't know how to code a procedure? How did you handle it?
- What coding system do you think is the most difficult to use? Why?
Hire the Best Qualified Revenue Integrity Analyst
A revenue integrity analyst plays a vital role in ensuring that a healthcare organization is reimbursed for its services. When hiring revenue integrity analysts, follow this guide to find the best candidates for the job. And don't forget to offer competitive compensation and benefits to attract top talent.