Revenue Integrity Manager

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Revenue Integrity Manager

Health Career Associates

Revenue Integrity Manager – Full Time

 

JOB SUMMARY:
The Revenue Integrity Manager will facilitate improvement in the overall quality, completeness and accuracy of the Revenue process. Reporting directly to the Revenue Cycle Director, this individual will work independently and be responsible for reviewing and analyzing information to identify trending and root-cause for billing and reporting issues. Develop and implement action plans for addressing and resolving all billing/charging issues. Will facilitate staffing and reporting changes to improve net revenue and reduction in denials. Provide support, education and guidance to Clinical and Administrative departments to maximize appropriate revenue for the Healthcare System.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.
2. *Responsible for Reporting in the Revenue Integrity Area
a. Establish and monitor revenue related Key Performance Indicators (KPI), metric goals, and reporting for the Revenue Integrity functions for the organization
b. Establish and monitor leadership approved aggregate revenue reporting and department level reporting across the organization, inclusive of baseline data/trends
c. Establish and maintain department level revenue reconciliation reports and tools
d. Monitor department owned charge review work queue volumes
3. *Revenue Integrity Workshops
a. Establish Revenue Integrity Workshops, roles & responsibilities, mission, purpose, and charter in preparation for the Epic Go-Live and for new revenue producing managers within the organization
b. Serve as a lead with department heads and other hospital personal and executives for the purpose of information gathering to enhance revenue integrity opportunities
c. Lead regular post-live Revenue Integrity Workgroup meetings with department leads, establishing a culture of accountably at the department level
d. Openly communicate issues and opportunities to appropriate
4.*Department Revenue Reconciliation
a. Work to ensure departments have the tools and reports needed to reconcile their revenue as well as identify training and educational opportunities
b. Assist in the development of standardized tools, resources and policies and procedures
5. *Management of the Revenue Integrity Team
a. Analyzes revenue impact associated with various projects to determine priority and value
b. Supervises the activities of the Revenue Integrity team, and ensures quality output on assignments
c. Provides regular status updates to Revenue Cycle leadership, and communicates relevant concerns and issues to the department as a whole as needed
d. Develop individual action plans for Revenue Integrity Associates improvement
e. Conduct interim and annual reviews for Revenue Integrity Associates
f. Manage Revenue Integrity resources and track department risks and mitigation progress
g. Maintain up-to-date knowledge of regulatory changes impacting charging practices
h. Act as a resource to Revenue Integrity Associates for complex questions, complicated cases, and compliance information
6. *Chargemaster
a. Will manage and assure a compliant chargemaster.
b. Work with Department Directors on developing new charges and pricing.
c. Revise and update the chargemaster when need arises
7. Compliance
a. Responsible to assure that billing is audited yearly to review compliance
b. Work with Legal to develop yearly audit plan and help implement
8. *Denials
a. In conjunction with the Senior Director of the Revenue Cycle, Lead the bi-monthly denials committee
b. Assure the denials committee is working towards avoidance on all avoidable denials throughout the Medical Center
c. Manage the Denials team to assure that denials inventory is worked and write-offs comply with the current policy and procedure.
9. Performs other related projects and duties as assigned.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Ability to be highly organized with strong analytical skills.
2. Skill in excellent communication and interpersonal skills.
3. Skill in coaching and educating peers and department directors.
4. Knowledge of computer hardware equipment and software applications relevant to work functions.
5. Ability to establish and maintain effective working relationships with all levels of personnel, medical staff, ancillary departments and volunteers.
6. Ability to prioritize work demands and work with minimal supervision.
7. Ability to communicate effectively both verbally and in writing.
8. Ability to maintain confidentiality relevant to sensitive information and HIPPA guidelines.
9. Ability to meet high standards for work accuracy and productivity.
10. Ability to maintain flexibility and prioritizes daily responsibilities.
11. Knowledge of charge master components (CPT codes, HCPCs, Revenue Codes, G/L and Cost centers.
12. Knowledge of inpatient, outpatient and clinical billing requirements.
13. Knowledge of coding guidelines and CMS reimbursement methodologies.
14. Skill in Epic Resolute Hospital Billing.
15. Knowledge of HIPAA rules and regulations and experience related to privacy laws, access and release of information.
16. Knowledge of Inpatient Prospective Payment System (IPPS), Coding Regulations and documentation requirements.

EDUCATION AND EXPERIENCE:
Bachelor’s degree in Business or related field required. Minimum five years health care with at least three years of Healthcare Finance or Accounts Receivable Management experience. Experience as Revenue Integrity Manager preferred. AAPC or AHIMA certification preferred and clinical nursing experience preferred.

Salary: Pay Rate Range $28.19-$42.74/hr. (Dependent upon experience) 

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