Revenue Integrity Analyst - Laboratory

ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following.  Other duties may be assigned.

**While this position may offer remote flexibility, we are seeking candidates who reside within the local area and can reliably attend onsite meetings, training sessions, team events, or other in-person business needs as required.

1. Charge Capture & CDM Management

• Maintain and update the laboratory chargemaster (CDM), ensuring accurate CPT/HCPCS codes, revenue codes, modifiers, and pricing.

• Validate LIS test builds and charge mapping to ensure alignment with billing rules and reimbursement requirements.

• Monitor payer policy changes and implement necessary CDM or workflow updates.

2. Revenue Integrity & Compliance

• Conduct routine audits of laboratory charges, coding accuracy, and billing workflows to identify missing charges, errors, or compliance risks.

• Review denials and reimbursement trends to identify root causes and recommend corrective actions.

• Ensure compliance with federal and state regulations, including Medicare guidelines, NCCI edits, and medical-necessity requirements.

3.Cross-Functional Collaboration

• Partner with laboratory leadership, billing, revenue cycle, finance, and IT to support accurate charge capture and timely reimbursement.

• Support new test implementation by coordinating pricing, coding, and charge workflows.

• Participate in LIS/EHR upgrades, charge router updates, and system optimization projects.

4. Documentation, Reporting & Education

• Develop and maintain documentation for CDM processes, charge capture workflows, and regulatory updates.

• Prepare reports on charge accuracy, denial trends, and revenue integrity metrics.

• Provide training to laboratory and revenue cycle staff on coding, billing, and charge capture requirements.

5. External Partner Support

• Collaborate with partner hospitals and client institutions to ensure CDM alignment and accurate invoicing for laboratory services.

• Support contract pricing reviews and charge-related inquiries from external stakeholders.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience:

High school diploma or general education degree (GED); Associate’s or Bachelor’s degree in Health Information Management, Business, Laboratory Science, or related field. Experience in revenue cycle operations, chargemaster maintenance, medical billing, or CPT/HCPCS coding; or 5+ years of experience as a medical technologist

Language Ability:

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Convey a skilled phone manner for handling internal and external customers’ issues.

Working knowledge of clinical laboratory operations and terminology.

Math Ability:

Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Reasoning Ability:

Ability to work independently; demonstrate initiative and analytical ability; and possess excellent verbal and written communication skills. Possess strong attention to detail, and highly organized. Demonstrate the ability to work with minimal supervision and direction. Ability to work well in a fast-paced professional office and laboratory environment. Strong analytical skills and ability to interpret regulatory guidance.