Revenue Integrity Nurse Analyst

Job Description

A healthcare organization in the Bay Area of Florida, is seeking a highly skilled Revenue Integrity Nurse Analyst (RN) to support clinical and financial excellence across the revenue cycle. This role will collaborate with physicians and cross-functional departments to ensure accurate charge capture, appropriate patient status, and compliance with CMS regulations including National and Local Coverage Determinations (NCDs/LCDs). The Revenue Integrity Nurse Analyst will play a key role in educating clinical teams, optimizing medical necessity documentation, and identifying opportunities for process improvement. This is an excellent opportunity for a registered nurse with a strong foundation in revenue cycle operations, clinical documentation improvement (CDI), and payer compliance.

Earnings

$90,000 -$127,504 salary

Duties

• Review patient accounts to validate medical necessity, billing accuracy, and patient status compliance.
• Serve as a subject matter expert on Medicare guidelines, billing rules, and payment methodologies (Medicare, Medicaid, and commercial payers).
• Collaborate with physicians and hospital staff to ensure accurate and compliant clinical documentation.
• Support charge capture integrity and assist in resolving issues impacting reimbursement.
• Identify trends, develop best practices, and recommend process improvements in revenue integrity workflows.
• Provide training and education to internal teams on CMS rules, documentation standards, and billing compliance.
• Monitor and advise on Medicare Inpatient-Only (IPO) list regulations and coverage policies.

Requirements

• 3+ years of experience in revenue cycle, case management, or utilization review in a healthcare setting.
• Prior medical auditing experience is a plus.
• Strong working knowledge of CMS billing guidelines, medical necessity rules, NCDs/LCDs, and payer reimbursement models.
• Experience with charge capture systems, EMR/EHR platforms, and billing workflow optimization.
• Excellent written and verbal communication skills and ability to build relationships across departments.
• Strong problem-solving skills, attention to detail, and ability to handle multiple projects in a fast-paced environment.
• Customer service orientation with a collaborative and professional demeanor.

License / Certification

• Registered Nurse (RN) license in the State of Florida (or ability to obtain
• Bachelor’s Degree in Nursing (BSN) required. Relevant RN experience may substitute year-for-year in lieu of degree.
• Coding certification (e.g., CCS, CPC, RHIA, RHIT) from AAPC or AHIMA (or ability to obtain within one year of hire).