Revenue Cycle Manager – Revenue Integrity Position Available In Western Connecticut, Connecticut

Revenue Cycle Manager – Revenue Integrity Stamford Health – 3.7

Stamford, CT Job Details Full-time Estimated:

$96.2K – $159K a year 4 hours ago Qualifications Microsoft PowerPoint Microsoft Word Microsoft Excel Management Medicare Managed care 5 years Healthcare Administration AHIMA Tableau Master’s degree Certified Professional Coder Analysis skills Supervising experience Bachelor’s degree Staff training Accounting Computer skills Business Administration Health information management Training & development Senior level Business Leadership Medical terminology Communication skills Full Job Description The incumbent is responsible for maintaining a balance of financial, operational, and regulatory requirements to ensure integrity of revenue, to include regular reports and monitoring of risk, partnering with Finance leadership on price variation and remediation, maintaining charge description master (CDM), involvement in appeals processes where appropriate, denials management optimization when relevant, revenue monitoring/oversight/training with revenue-generating departments (charge capture and reconciliation partnership), and escalating issues with managed care contracting and commercial payers as identified to Managed Care. This person will exhibit strong analytical, problem solving, verbal and written communication skills, demonstrate the ability to manage conflict, and have a working knowledge of hospital and medical group operations. The role must also have the ability to manage both clinical and non-clinical workgroups across the health system. The Manager, in collaboration and consultation with the Director of Revenue Cycle, Mid-Cycle and the Executive Director of Revenue Cycle, is responsible for standardizing revenue integrity processes and implementing best practices across the organization, ensuring compliance and revenue enhancement opportunities are met and maintained. The incumbent coordinates with the Directors of Front End and Back End, the Managers of HIM and Coding and clinical operations senior leadership in the development and execution of the revenue cycle strategy for revenue integrity under the direction of the Executive Director of Revenue Cycle and the Chief Financial Officer. Key Responsibilities – Provides oversight of hospital and physician practices revenue integrity operations, including monitoring and supporting gross revenue generation, capture and reconciliation and ensuring regulatory compliance. Establishes and maintains an accurate and compliant Charge Description Master (CDM). Drives best practices and leads a re-design of key revenue integrity and training processes as necessary to ensure optimal efficiency and the achievement of revenue cycle performance indicators. Identifies gaps in current revenue integrity processes and takes proactive and creative steps to close those gaps to improve performance. Assists the Executive Director of Revenue Cycle with the planning of strategic revenue cycle processes and implements as necessary. Provides oversight for revenue monitoring and serves as a liaison for revenue generating departments. Performs ongoing analysis and review of revenue integrity performance, quantifies, recommends, implements and monitors revenue enhancement opportunities. Develops management reports for distribution and review, incorporating leading practice benchmarks. Responsible for charge related audits and actively engages with owning areas in the creation and monitoring of appeal letters due to denials. Develops and implements best practice revenue management policies and procedures that guide revenue integrity performance and support defined service level and key performance indicator metrics. Ensures that operational processes and technology are aligned and integrated to enable effective and efficient realization of the organization’s full revenue potential. Works collaboratively with clinicians, auditors, revenue cycle services, and information services to understand services provided to explore and capitalize on opportunities for enhanced revenue integrity (minimize charge leakage, maximize compliant reimbursement). Partners with Denials Prevention leader to engage Information Services remediating and/or enhancing system functionality to provide improved decision support for denials management. Collaborate with key stakeholders to assist in the implementation of enterprise-wide revenue based remediation based on regulatory requirements. Remains up to date on regulatory, reimbursement and payer-related billing changes impacting the Enterprise and develops and implements processes to maintain and support compliance with federal and state regulations. Partners with Legal and Compliance with outside government entities regarding audits including but not limited to RAC, MAC and/or OIG. Ensures recruitment and retention of talented staff in accordance to the standards set forth by the health system. Coordinates with all revenue cycle functions in compliance with the standards of the health system leadership, medical staff and outside regulatory/accreditation agencies. Builds and integrates customer-centric revenue integrity and training processes and ensures a strong culture of customer service and outstanding performance. Performs such individual assignments as management may direct. Establishes and maintains effective working relationships within the organization. Provides information to senior levels of management on the implication of policies and procedures being formulated and recommends specific action. Operationalizes the department’s goals in alignment with revenue cycle and finance teams’ senior leadership. Manages the hiring, orienting, and development of staff. Responsible for the training and education of staff including annual compliance. Conducts employee evaluations, coaching, and corrective actions to align employee performance and behaviors. Provides direction and support to subordinate staff to ensure effectiveness and efficiency. Implements and enforces department policies. Clarifies and supports organizational policies and procedures. Keeps abreast of all standards to ensure compliance with orders and directives issued by regulatory or third-party payers. Engages in continuous study of the entire professional field, including best practices, to maintain the professional competence, knowledge, and skills necessary for the satisfactory performance of all assigned responsibilities. Attends mandatory meetings and in-services as required for this position. Other duties in support of revenue cycle operations, as assigned by manager, including ad-hoc reporting and trend analysis. Demonstrates support for the mission, values, and goals of the organization through behaviors that are consistent with the standards of Stamford Health System. Networks and builds relationships with others in similar organizations. Performs other duties as assigned. Baccalaureate Degree required. Master’s degree in Business Administration, Healthcare Administration or relevant equivalent highly desirable. Active CPC designation preferred. Minimum 5 years management/supervisory experience. At least seven years of revenue cycle experience required. Previous middle revenue cycle experience (HIM, CDI, Coding, RI) at a manager level or above within a healthcare setting preferred. Experience with leading and/or building a revenue integrity program a plus. Professional certification from reputable organization within the industry desirable (HFMA, HIMSS, AHIMA, AMA). Superior verbal and written communication and presentation skills to effectively address all levels within the organization establishing effective relationships with other operational leaders, executives, physicians, and staff-level employees. Knowledge and expertise across all aspects of healthcare revenue cycle functions, including registration, coding and documentation standards, billing and collection processes and government and payer regulations. Knowledge of CMS regulations, medical terminology and the various data elements associated with all types of claims. Knowledge of local, state and federal regulatory requirements related to compliant charge capture and billing practices. Ability to effectively establish/manage priorities and organize work structure in a fast-paced environment. Experience with creating education materials and training staff on Revenue Cycle processes and workflows. Strong analytical capacity with reporting capabilities, as needed. Proficiency in desktop computer programs such as Microsoft applications (Excel, PowerPoint, Word, Outlook). Familiarity with patient accounting systems and related business office adjunct systems (Tableau, etc.). Knowledge of healthcare regulatory requirements, charge audits and appeals with prior experience in healthcare compliance and legal requirements. Sound understanding of Medicare, Medicaid, Other Government, Managed Care and Commercial, Third-Party Liability (TPL) payer plans as well as knowledge of medical terminology and standard coding conventions. Demonstrated knowledge of managed care payer requirements in acute and ambulatory settings. Commitment to HIPAA by using, protecting, and disclosing patients’ protected health information (PHI) only in accordance with regulatory standards. Strong organizational, interpersonal and communication skills required. A commitment to continuous learning shown through membership in professional organizations like HFMA, HIMSS, AHIMA, AHIA, MGMA and/or relevant industry standard certifications a plus. This is a remote position but candidate would be required to live in the Tri-state area, Connecticut, New York or New Jersey.