Manager, Professional Revenue Integrity

Role Overview

• Overseeing and managing all aspects of professional charge functions to ensure the integrity of the organization’s revenue
• Summarizing findings to support the development of processes and procedures
• Collaborating with Revenue Cycle, Clinical Departments, and Finance to ensure accurate revenue capture, compliance, and optimization
• Supporting the ongoing integrity of charge activity inclusive of technical and operational workflow and functionalities
• Managing all facets of professional revenue integrity processes to achieve and exceed best practice benchmarks
• Serving as liaison between revenue cycle and clinical departments
• Ensuring a process is in place to reconcile charges back to the daily ancillary and clinic patient schedules
• Monitoring daily reconciliation reports to assist departments in maintaining accurate and timely charges
• Maintaining current working knowledge of billing systems, claim submission, remittance advices, explanation of benefits, reimbursement methodology, payer systems, payer requirements, general coding, APC, CPT and HCPCs
• Closely monitoring volumes and performance of charge review work queues, charge edits, and reports while actively seeking opportunity, deficiencies, and improvement strategies
• Supporting best practices for professional services coding and clinical documentation
• Participating in corrective actions in response to variances and trends
• Ensuring that the activities of the professional revenue integrity team are conducted in a manner that is consistent with overall department protocol, Policies and Procedures, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements
• Managing staffing levels and productivity
• Providing team communication regarding department updates, organizational activities, financial performance, educational opportunities, interdepartmental activities, and QI activities
• Ensuring the recruitment, training, and retention of motivated, competent revenue integrity analysts; establishing goals and standards for performance appraisals
• Complying with HIPAA and all relevant laws, rules regulations and accreditation standards and requirements

Requirements

• Previous Revenue Integrity experience preferred
• Experience working for a large healthcare system highly preferred
• Must have Epic experience
• prefer a super-user
• Well-rounded and extensive background in Revenue Cycle
• Heavy project management experience
• Extensive data analysis capabilities
• Knowledge of medical coding would be helpful
• Open to candidates with front end business office experience and back end Revenue Cycle experience
• Five (5) years of Physician/Professional Billing experience required
• Three (3) years in a management or supervisory level position for a large health system preferred
• Extensive knowledge and experience with Epic EMR system, specifically with EPIC Resolute Billing with a large health system
• Experience in Charge Capture, Charge Reconciliation, and Charge Pricing
• Comprehensive understanding of healthcare billing and coding systems (e.g., HCPCS, ICD-10)
• Supervisory and mentoring skills necessary to provide support to department and promote employee development
• Advanced proficiency in Microsoft Excel and other Microsoft Business applications (i.e. Word, PowerPoint)

Benefits

• Health insurance
• Professional development opportunities