Description

SUMMARY: The Revenue Integrity Manager will assist in implementing procedures to achieve the fiscal goals. This position works collaboratively with the Finance and the compliance team.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Ensure compliance with all regulations, policies and procedures related to medical billing for OASAS and OMH facility charges and services. 
• The Revenue Integrity Manager reviews systems and processes to identify potential compliance issues, works with appropriate departments to correct such issues, serves as the internal resource for billing-related questions, provides training related to appropriate billing, and works with various departments to help ensure billing compliance.
• Performs other related duties as assigned to achieve the goals and objectives of the department and the organization.

• Completes capture of patient revenue in every area that generates charges, management in relation to charging mechanisms and triggers, ensuring clean handoffs between clinical departments, denials management, billing management and clinical operations relations.

• Fosters partnering relationships with the Compliance department, and other third parties to ensure the accuracy of the Charge Description Master (CDM) and fee schedules.

• Review of monthly reports to provide educational feedback on areas of possible documentation improvement to staff and providers.

• Assist in the maintenance of reports to external agencies, including the New York State Offices for Mental Health (OMH), and Alcoholism and Substance Abuse Services (OASAS).

• Other duties and responsibilities may be assigned.

COMPETENCIES (KSAs)

• Leadership

• Initiative

• Ethical Practices

• Judgment

• Relationship Management

• Emotional Intelligence

• Professional Boundaries

• Global and Cultural Awareness

• Critical Evaluation

• Problem Solving

• Decision Making

• Communication

• Teamwork

• Crisis Management

• Technical Capacity

Qualifications

REQUIRED EDUCATION

• Bachelor’s degree in business management, accounting or related field. 

REQUIRED LICENSE/CERTIFICATIONS

• N/A

REQUIRED EXPERIENCE

• Knowledge of reimbursement regulations for Medicare, Medicaid and Managed Care.
• Experience in management of clinical billing or healthcare experience required with knowledge of ICD-10-CM and CPT coding principles and guidelines.
• Computer literacy required including working knowledge of relevant software packages such as Microsoft Office.
• Proven communication, organizational, and leadership skills. 

WORK ENVIRONMENT

• This job operates in an indoor office environment. This role routinely uses standard office equipment such as computers, phones and photocopiers.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties and responsibilities of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.

• Regularly required to sit, use hands to type, handle or feel objects, tools or controls; reach with hands and arms, and talk or hear.
• Frequently required to stand, walk, stoop, kneel or crouch and lift and/or move up to 30 pounds.