Revenue Integrity Analyst in Pittsfield, Massachusetts at Berkshire Health Systems

The Revenue Integrity Analyst is responsible for identifying, analyzing, and resolving reimbursement variances to ensure Berkshire Health Systems receives accurate payment in accordance with payer contracts, fee schedules, and applicable regulatory requirements. The position primarily utilizes reimbursement analytics tools to compare expected versus actual payments, identify payer underpayments, investigate payment discrepancies, support appeals and recovery efforts, and monitor payer compliance with contractual reimbursement terms. Working collaboratively and supporting Revenue Cycle, Patient Financial Services, Payor Contracting, Information Technology, and operational leaders, this role evaluates reimbursement trends, determines root causes of payment variances, assists with contract modeling and system validation, and recommends process improvements that strengthen payment accuracy and net revenue. Knowledge of Medicare, Medicaid, and commercial payer reimbursement methodologies, hospital billing practices, and contract interpretation is important to the role. Charge capture, coding, documentation, and denial analysis may be performed as needed to support reimbursement investigations and payment recovery.