Revenue Integrity Analyst, Medical Biller

Role Overview

• Optimize and validate MHS GENESIS / Cerner charge capture workflows, CDM logic, billing rules, and revenue cycle configuration.
• Conduct charge capture validation, reconciliation of clinical activity to billing outputs, and identification of DNFB risks and revenue leakage.
• Audit documentation and coding (ICD‑10‑CM, CPT/HCPCS, modifiers) to ensure NCCI, LCD/NCD, TRICARE, and DHA compliance.
• Investigate claim edits and denials using Alpha II, SSI, or related tools; identify root causes and implement sustainable solutions.
• Perform payer remittance analysis to uncover denial trends, modifier issues, bundling errors, and reimbursement gaps.
• Support UB‑04 and CMS‑1500 billing accuracy and troubleshoot errors impacting payer acceptance or reimbursement.
• Analyze clinical, financial, and operational data to identify trends and develop data‑driven recommendations for revenue improvement.
• Use MHS GENESIS/Cerner analytics tools (HealtheAnalytics, HDI) to interpret dashboards and monitor performance metrics.
• Prepare executive‑level reporting and visualizations to communicate findings, risks, and remediation strategies.
• Partner with coding teams, clinicians, IT analysts, billing offices, and leadership to resolve issues and ensure standardized workflows.
• Participate in or lead enterprise-level remediation planning, including root cause analysis, corrective action tracking, and workflow optimization.
• Provide staff education on coding, documentation requirements, and revenue cycle best practices.
• Recommend and implement workflow improvements to reduce denials, increase first-pass payment rates, and enhance compliance.
• Identify and escalate systemic issues affecting charge capture, coding, billing, or payer processing.

Requirements

• Must be able to OBTAIN and MAINTAIN a Federal or DoD 'PUBLIC TRUST'; candidates must obtain approved adjudication of their PUBLIC TRUST prior to onboarding with Guidehouse.
• Bachelor’s Degree; FOUR (4) years of additional professional experience may be used in lieu of a degree
• THREE (3) or more years of Revenue Cycle Management (RCM) build experience, including troubleshooting, system reconfiguration, and/or project management.
• Proficiency in ICD‑10‑CM, CPT/HCPCS, modifiers, NCCI, and federal billing regulations (TRICARE, DHA).
• Understanding of Chargemaster (CDM) structure and charge reconciliation processes.
• Experience with MHS GENESIS / Cerner, charge capture, billing workflows, and revenue integrity functions.
• Strong skills in denial root cause analysis, remittance interpretation, and claim lifecycle management
• Familiarity with claim scrubber tools, billing systems, and payer edit logic.
• Strong analytical and critical‑thinking skills with ability to interpret complex data and interpret Excel‑based or system‑generated dashboards.
• Effective communication skills with the ability to train, educate, and influence stakeholders.
• Understanding of healthcare billing, medical necessity, and revenue cycle operations.
• Experience working within the Military Health System (MHS) or other federal health systems.
• Background in hospital or professional billing environments.
• Certifications such as CPC, CCS, CPMA, or RHIT/RHIA.
• Prior consulting experience or participation in large‑scale EHR or revenue cycle implementations.

Benefits

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave and Adoption Assistance
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Student Loan PayDown
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program
• Mobility Stipend