Revenue Integrity Program Manager

84748

BR Shared Service Center Job Posting Description Position Summary:

Manager, Revenue Integrity Program (hybrid)

Key Responsibilities:

1. Helps ensure adequate training and education occurs to both providers and foundations staff regarding accurate charge capture and documentation requirements. 2. Oversees Charge Reconciliation and Charge Capture processes and training materials. Develops, documents, and maintains effective charging policy, procedures and training materials for the PO and Shared Service Center. 3. Works directly with foundations and other key staff of revenue producing departments to identify billable services and establish the charge process. 4. Participates in research of billing and coding requirements when new procedures and/or supplies are introduced. If appropriate to bill for new services, ensures related systems are set up correctly, tested, and monitors initial charging of services for proper billing as well as following claims for initial reimbursement. 5. Liaises with key stakeholders including Foundations, Finance, Compliance, HIM, Coding, CDI, Clinical Departments, Information Technology, as well as others. 6. Facilitates the dissemination of information regarding government and third-party payer regulations and requirements to foundations, providers, management and staff, as applicable. 7. Oversees communication of coding and billing updates published in third-party payer newsletters/bulletins and provider manuals to all stakeholders as appropriate. 8. Works collaboratively with Professional Coding, Foundations and Compliance (when indicated) with performing appropriate reviews, investigating trends and patterns, and providing education regarding documentation, charge capture, charge reconciliation, billing/coding guidelines and denials. Ensures reviews are conducted on an annual basis and/or as otherwise identified, in all areas treating patients to ensure all professional billable charges are captured and coded completely and accurately, and documentation reflects same. 9. Maintains a revenue optimization database, communicates and coordinates resolution of opportunities. Presents and communicates findings, trends, mitigation efforts and recommendations to established Committees and key stakeholders. 10. Assists and makes recommendations for third-party payer contract language related to clinical coding standards and requirements. 11. Develops and monitors metrics to ensure functions of the Revenue Integrity team are performed efficiently as well as with a high degree of accuracy and customer service. 12. Demonstrates support for the mission, values and goals of the organization.

Knowledge of Healthcare Revenue Cycle:

Understanding of billing, coding, collections and regulatory requirements. Strong knowledge of medical billing, coding (ICD-10, CPT, HCPCS) and payer policies. Working knowledge of financial principles and metrics related to effective revenue cycle management.

License preferred:

Clinical license such as Registered Nurse (RN), Registered Respiratory Therapist (RT), Medical Technologist (MT), Registered Pharmacist (RPh) Certification preferred: Coding certification such as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or AHIMA Certified Coding Specialist (CCS). Project Management Professional (PMP).

Minimum Qualifications Education:

Required Bachelor's degree or equivalent experience

Experience:

8-10+ years of progressively responsible healthcare revenue cycle experience, with a strong focus on professional billing required. Direct management experience. Experience within a multi-specialty physician organization preferred. Status Full-Time Regular, Temporary, Per Diem Regular Standard Hours per Week 40 Pay Range $99153.60-$158631.20 Annual Office/Site Location Westwood Job Posting Category Accounting/Finance Remote Eligibility Part Remote/Hybrid