Revenue Integrity Service Line Analyst

About The Wilshire Group

The Wilshire Group is a healthcare consulting organization focused on helping clients improve revenue cycle performance through experienced professionals, practical solutions, and collaborative partnership.

The Wilshire Group is an equal opportunity employer and values a collaborative, professional, and inclusive work environment.

Revenue Integrity Service Line Analyst

Position Summary

The Wilshire Group is seeking three experienced Revenue Integrity Service Line Analysts to support revenue integrity initiatives in a fully remote consulting environment. This role will work closely with physicians, clinical, operational, finance, compliance, coding, IT, and revenue cycle teams to improve accurate and compliant revenue capture. The ideal candidate will have strong Epic and chargemaster experience, along with the ability to review end-to-end workflows, identify revenue opportunities, and help implement practical, sustainable improvements.

Key Responsibilities

Serve as a Revenue Integrity resource for assigned clinical service lines and partner with physicians, clinical, operational, finance, compliance, coding, patient access, HIM, IT, and revenue cycle stakeholders.

Review the relationship between the chargemaster (CDM), clinical workflows, Epic configuration, charge capture logic, and downstream billing processes.

Maintain Epic chargemaster content within assigned areas and apply knowledge of charge capture, charge router logic, billing workflows, reimbursement, Epic revenue cycle functionality, and charging functionality within related Epic clinical modules for designated areas of focus.

Perform end-to-end assessments of scheduling, documentation, charge capture, billing, reimbursement, and payment workflows to identify opportunities for improvement.

Identify root causes of missed, inaccurate, or incomplete charges and recommend and implement corrective actions.

Work with business and technical teams to improve workflows, system configuration, documentation, and charge capture processes, including increasing automation when possible.

Analyze operational, financial, and utilization data to identify trends, charging variances, underpayments, missed revenue, and other revenue optimization opportunities.

Monitor implemented changes and measure results to confirm improvements are working as intended.

Support or lead Revenue Integrity assessments for new clinical programs, technologies, procedures, and service lines.

Maintain knowledge of federal and state regulations, payer requirements, CPT, HCPCS, ICD-10-CM/PCS, NCCI, Medicare guidance, and revenue cycle best practices.

Provide guidance to other analysts as needed. More senior candidates may also serve as a subject matter expert or mentor on complex revenue integrity issues.

Experience and Skills

Advanced knowledge of hospital and professional revenue cycle operations, including revenue integrity, charge capture, coding, billing, and reimbursement.

Strong Epic revenue cycle experience, including chargemaster/CDM management, charge router functionality, charging workflows, and workflow optimization.

Ability to evaluate clinical and revenue cycle workflows across multiple service lines and turn findings into practical recommendations.

Strong analytical, critical-thinking, and problem-solving skills, including the ability to identify root causes and assess financial impact.

Ability to independently manage priorities and work effectively with cross-functional teams in a remote environment.

Strong communication and relationship-building skills with the ability to explain revenue cycle and technical concepts to operational leaders and stakeholders.

Qualifications

Bachelor's degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or a related field, or an equivalent combination of education and experience.

Progressive Revenue Integrity experience, including service line assessments, revenue optimization, and cross-functional initiatives.

Epic Revenue Integrity/Chargemaster certification or demonstrated Epic Revenue Cycle experience preferred.

Revenue integrity, coding, or revenue cycle certification preferred (CPC, COC, CCS, CHRI, CRCR, or equivalent).

Clinical experience or clinical education/credentials, such as RN or another relevant clinical background, is a plus for senior-level candidates.