Revenue Integrity Analyst

Why Orthofix?
    

Guided by our organizational values – Take Ownership | Innovate Boldly | Win Together – we collaborate closely with world-class surgeons and other partners to improve people’s quality of life. At Orthofix, we want team members who build relationships and share knowledge, challenge the status quo, and deliver results every day to help us achieve our vision to be the unrivaled partner in Med Tech.  

Our global team of over 1,600 employees brings to market highly innovative, cost-effective, and user-friendly medical technologies that heal musculoskeletal pathologies for patients and the healthcare professionals who treat them. Looking to change people’s lives? Look no further.

JOB PURPOSE

The Revenue Integrity Analyst – DME/Healthcare is responsible for driving revenue optimization and minimizing preventable write-offs through comprehensive analysis of denied and uncollectable claims across commercial, federal, and third-party liability payers. This role provides critical insight into denial trends, payer behaviors, and internal process breakdowns across the order-to-cash lifecycle, including intake, documentation, billing, and collections.

Through advanced analytics, cross-functional collaboration, and subject matter expertise in DMEPOS reimbursement, the Revenue Integrity Analyst identifies root causes of revenue leakage and delivers actionable recommendations to improve operational workflows, enhance documentation accuracy, and strengthen payer alignment. This position plays a key role in supporting financial performance, ensuring compliance with payer requirements, and advancing revenue cycle excellence through data-driven decision-making and continuous process improvement.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The following are the essential functions of this position. This position may be responsible for performing additional duties and tasks as needed and assigned.

• Conduct detailed reviews of third-party claims (including commercial, federal, and third-party liability payers) classified as uncollectable to validate root causes and confirm all appropriate collection efforts have been exhausted

• Analyze denial drivers, including but not limited to timely filing, documentation deficiencies, authorization issues, eligibility errors, benefit exclusions, non-contracted status, coding or place-of-service inaccuracies, and invalid or incomplete prescriptions

• Differentiate between payer-driven denials and internal operational breakdowns across order intake, clinical documentation, billing, and follow-up workflows

• Identify, categorize, and quantify denial and write-off trends across payers, product lines, and internal functional areas to uncover systemic revenue leakage

• Develop and deliver recurring reporting (monthly and quarterly) highlighting key findings, financial impact, and prioritized, actionable recommendations

• Present insights and strategic recommendations to Order-to-Cash, Revenue Cycle, and Sales leadership, translating complex reimbursement issues into clear, executive-level guidance

• Partner cross-functionally with Order Processing, Billing, Sales, and Payer Relations teams to address root causes and implement sustainable process improvements

• Support the implementation, monitoring, and effectiveness tracking of corrective actions, including training initiatives, workflow redesign, and documentation standardization

• Maintain a strong working knowledge of payer policies, coverage criteria, and DME billing requirements to ensure accurate analysis and recommendations

• Contribute to continuous improvement initiatives focused on denial reduction, revenue recovery, and operational efficiency across the revenue cycle

MINIMUM QUALIFICATIONS

Education/Certifications:

• Bachelor’s degree in Healthcare Administration, Business, or related field, or equivalent combination of education and experience

Experience, Skills, Knowledge and/or Abilities:

• Minimum of 3 years of experience in healthcare revenue cycle, preferably within DMEPOS, medical device, or related reimbursement environments

• Strong understanding of the full claims lifecycle, including billing, adjudication, denials management, and appeals processes

• Experience reviewing claims for documentation accuracy, compliance, and payer alignment (non-financial audit focus)

• Familiarity with commercial, federal, and third-party liability payer requirements and common denial drivers

• Strong analytical and problem-solving skills, with the ability to identify trends and translate findings into actionable insights

• Proficiency in Microsoft Excel and/or reporting tools for data analysis, visualization, and presentation

• Effective communication skills, with the ability to collaborate across cross-functional teams and present findings to leadership

• High attention to detail with the ability to manage multiple priorities in a fast-paced, deadline-driven environment

PREFERRED QUALIFICATIONS

Education/Certifications:

• Certified Professional Biller (CPB) – AAPC

• Certified Professional Coder (CPC) – AAPC

• Certified Revenue Cycle Representative (CRCR) – Healthcare Financial Management Association

• Certified Revenue Integrity Professional (CRIP) – Healthcare Financial Management Association

Additional Experience, Skills, Knowledge and/or Abilities:

• Direct experience in DMEPOS billing and reimbursement, including familiarity with HCPCS (E-codes) and Medicare/DME MAC policies

• Experience in denials management, appeals, or revenue integrity functions within a healthcare setting

• Knowledge of payer policy interpretation, including Local Coverage Determinations (LCDs), coverage criteria, and prior authorization requirements

• Demonstrated experience identifying root causes and driving corrective actions across intake, documentation, and billing workflows

• Understanding of payer contracting concepts, including allowable rates, coordination of benefits, and out-of-network considerations

• Advanced Excel skills, including pivot tables, data modeling, and trend analysis

• Experience working cross-functionally within Sales, Operations, and Reimbursement teams in a matrixed organization

• Ability to translate complex reimbursement and operational issues into clear, concise, executive-level insights and recommendations

PHYSICAL REQUIREMENTS / ADVERSE WORKING CONDITIONS

The physical requirements listed in this section include but are not limited to the motor/physical abilities, skills, and/or demands required of the position in order to successfully undertake the essential duties and responsibilities of this position.  In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to allow qualified individuals with a disability to perform the essential functions and responsibilities of the position.

• Must be able to lift and transport products, literature to customer sites repetitively throughout each day.

• Lifting capacity up to approximately 20 to 30 pounds.

• Travel by auto and plane frequently. 

• Ability to use PC or laptop computer and cell phone effectively.

• Eyesight and hearing must be correctable to standard level.

DISCLAIMER

The duties listed above are intended only as representation of the essential functions of this position.  The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.  The job description does not constitute an employment agreement between the employer and employee and is subject to change at the sole discretion of the employer.  Nothing in this document alters an employee’s at-will employment status.

The anticipated salary for this position is  between $65,000.00 - $75,000.00 per year, (plus bonus based on performance) and benefits.

DISCLAIMER

The duties listed above are intended only as representation of the essential functions of this position.  The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.  The job description does not constitute an employment agreement between the employer and employee and is subject to change at the sole discretion of the employer.  Nothing in this document alters an employee’s at-will employment status.

We are committed to providing equal employment opportunities to all employees and applicants without regard to race (including traits historically associated with race, such as hair texture and protective hairstyles, including braids, locks, and twists), ethnicity, religion, religious creed (including religious dress and grooming practices), color, caste, sex (including childbirth, breast feeding, and related medical conditions), gender, gender identity or expression, sexual orientation, national origin, ancestry, citizenship status, uniform service member and veteran status, marital status, pregnancy, age (40 and over), protected medical condition (including cancer and genetic conditions), genetic information, disability (mental and physical), reproductive health decision-making, medical leave or other types of protected leave (requesting or approved for leave under the Family and Medical Leave Act or the California Family Rights Act), domestic violence victim status, political affiliation, or any other protected status in accordance with all applicable federal, state, and local laws.

This policy extends to all aspects of our employment practices including, but not limited to, recruiting, hiring, discipline, termination, promotions, transfers, compensation, benefits, training, leaves of absence, and other terms and conditions of employment.