Job Description
at Christiana Care Health System in Wilmington, Delaware, United States Job Description Job Details Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values ofLoveandExcellenceand are passionate about delivering health, not just health care. Come join us at ChristianaCare! ChristianaCare, with Hospitals in Wilmington and Newark, DE, as well as Elkton, MD, is one of the largest health care providers in the Mid-Atlantic Region. Named one of "America's Best Hospitals" by U.S. News & World Report, we have an excess of 1,100 beds between our hospitals and are committed to providing the best patient care in the region. We are proud to that Christiana Hospital, Wilmington Hospital, our Ambulatory Services, and HomeHealth have all received ANCC Magnet Recognition.
PRIMARY FUNCTION
The Manager, Physician Revenue Integrity is responsible for operational management, stabilization, and optimization of Professional Billing (PB) locations as it relates to the professional fee schedule, Epic Charge Generation Tracker (CGT), payer billing rules/regulations, denial prevention, charge capture, and charge reconciliation for all billable professional services. Additionally, this role is responsible for defining efforts and focus areas to address denial root cause in collaboration with PB Revenue Cycle Managers. The Manager, Physician Revenue Integrity acts as the primary contact for providers, clinical, and administrative staff to answer coding questions related to evaluation and management services, office-based procedures, and bedside procedures and initiates research related to revenue enhancement and correct coding for Epic PB clinical charge capture. PRINCIPAL DUTIES AND RESPONSIBILITIES
Develops, implements, and oversees effective and consistent operational policies, processes, tools, and educational materials within PB Revenue Integrity functional areas. Ensures Revenue Integrity staff compliance with all established policies, processes, and quality assurance programs. Collaborates with IT and respective teams to develop dashboards and potential automated monitoring for charge capture, claim edits, and payer rule changes. Serves as the operational lead for Epic PB enhancements, ensuring effective change management, communication, testing, and adoption of new functionality across clinical and administrative teams. Evaluates and optimizes Epic Charge Generation Tracker (CGT) configuration to support compliant charging, reduce denials, and support accurate pricing strategies. Owns the tactical framework for denial prevention related to charge capture, coding (when applicable), and payer edits; collaborates with PB Revenue Cycle Managers to operationalize sustainable root-cause solutions. Ensures continuous regulatory readiness by maintaining compliant charge capture workflows, partnering with Compliance as needed for routine internal audits, external audit response, and corrective action planning. Develops team capability through ongoing coaching, structured training plans, and performance development planning. Leads the establishment and implementation of Key Performance Indicators (KPIs) for PB revenue integrity functions; ensures the implementation of action plans where performance is not meeting expectations; reviews KPI expectations annually and adjusts appropriately. Oversees code and payer coverage analysis for new services/products. Manages daily activities of revenue integrity areas. Audits unbilled work queues for root causes (pre-bill edits) and uncoded services. Provide guidance to revenue integrity analysts. Reviews detailed daily/weekly/monthly dashboard reports for each entity, including work queue volumes, denial trends and key performance indicators, and takes appropriate action to ensure department/organizational goals are being met. Builds and maintains a close relationship with payer provider representatives to ensure proper claim processing. Maintains comprehensive knowledge of regulatory requirements related to third party billing rules. Responds to inquiries with regards to CMS policies, third party payer guidelines, and billing department protocols. Reviews communications received from third party payers and shares information with impacted personnel. Prepares and revises policies and procedures as warranted and conducts in-service/meetings with caregivers. Safeguards the integrity of billed accounts by ensuring compliance with billing, documentation,... For full info follow application link. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law. To view full details and how to apply, please login or create a Job Seeker account
