Surgical Services Revenue Integrity Analyst (Charge Capture and CPT Specialist)

Surgical Services Revenue Integrity Analyst (Charge Capture & CPT Specialist)

Surgical Services

Senior Director of Surgical Services

Revenue Integrity / HIM Coding

The Surgical Services Revenue Integrity Analyst is responsible for ensuring accurate, complete, and compliant charge capture and CPT code assignment across all perioperative and procedural areas. This role applies advanced knowledge of clinical documentation, coding guidelines, and revenue cycle processes to validate that services rendered are appropriately captured and billed. Serving as a key liaison between Surgical Services, Revenue Integrity, HIM Coding, and Finance, this position performs detailed audits of clinical and billing data, identifies revenue leakage, and drives process improvements to optimize reimbursement while maintaining regulatory compliance.

Charge Capture & Clinical Validation - Conduct routine and ad hoc audits of surgical and procedural cases to ensure all billable services, supplies, implants, and medications are accurately captured. - Validate that clinical documentation supports charges, CPT code selection, and level of service. - Reconcile discrepancies between clinical documentation, preference cards, and charges within the EMR (e.g., Epic). CPT Code Development & Maintenance - Partner with Revenue Integrity and Coding teams to develop, validate, and maintain CPT code mappings for surgical and procedural services. - Review new procedures, equipment, and service line expansions to ensure appropriate CPT assignment and charge structure. - Ensure alignment between procedure scheduling, CPT coding, and actual case performance. Revenue Integrity & Compliance - Adhere to CPT, HCPCS, ICD-10, and regulatory billing guidelines. - Support denial management efforts by identifying root causes related to coding inaccuracies or documentation gaps. - Participate in internal and external audits. Auditing & Data Analysis - Analyze trends in charge capture accuracy, missed charges, and coding discrepancies. - Develop audit criteria and reporting tools to monitor performance. - Utilize EMR reporting tools and billing platforms to validate accuracy. Process Improvement - Evaluate workflows related to charge entry, documentation, and billing. - Implement standardized processes across procedural areas. Education & Leadership Support - Educate physicians, nurses, and surgical staff on documentation and charge capture expectations. - Serve as a subject matter expert for coding and billing questions.

Education: - Bachelor's degree in Health Information Management, Nursing, Healthcare Administration, or related field required - Master's degree preferred Experience: - 3-5 years of experience in healthcare revenue cycle, surgical services, coding, or charge capture - Experience in perioperative services strongly preferred - Experience with EMR systems (Epic preferred) Certifications: - CPC, CCS, RHIT, or RHIA preferred or required within defined timeframe - CNOR preferred

- Advanced understanding of CPT/HCPCS coding and procedural billing practices - Knowledge of ICD-10 and healthcare reimbursement systems - Strong analytical and auditing skillset - Ability to manage audits and prioritize workload - Strong communication and collaboration skills - High attention to detail and compliance focus

- Charge capture accuracy rate - Reduction in missed charges / revenue leakage - Denial rate related to coding and documentation - Charge lag - CPT and case time accuracy alignment

Hybrid clinical and office-based role with routine presence in perioperative areas.

This role is critical to the financial performance of Surgical Services by ensuring that all services provided are accurately documented, coded, and billed. It directly contributes to revenue optimization, compliance, and operational excellence.