Revenue Integrity Manager

The Revenue Integrity Manager is responsible for management and coordination of all Revenue Integrity charge capture activities throughout the organization. This includes the development of processes and procedures necessary to ensure accurate and timely capture of all chargeable procedures and oversight of all charge reconciliation processes. Also responsible for maintaining communication with key stakeholders regarding updates to charge capture processes to ensure charge capture accuracy is maintained and adhered to. Performs oversight of process adherence through regular reviews of chargeable services and activities and provides feedback and education to Senior Leadership, Service Line Leaders and colleagues on process improvements and areas of opportunity for revenue enhancement.

POSITION RESPONSIBILITIES:

1. Responsibilities include all aspects of Revenue Cycle support including performance improvement, documentation, development, testing, training, upgrades, and assist management and senior leadership in examining processes to improve workflow.
2. Compiles and analyzes data to develop recommendations leading to potential revenue cycle opportunities, include analyses related to CDM set-up, charge capture, and billing.
3. Provides analysis, trended reports and well supported documentation for audit findings, recommendations and/or corrections to individual hospital processes according to best practice, compliance and policy.
4. Maintains knowledge of an organizational compliance with state, federal, and other third-party payer billing and reimbursement guidelines.
5. Conducts charge capture assessment activities including interviews, research, and outcomes analysis. Provides analysis, well-supported documentation and recommendations for changes, additions and/or corrections to the CDM according to best practice and company standards.
6. Provides support, communication and education to multiple facilities and corporate staff on correct charge capture, billing and coding processes, and state and federal guidelines.
7. Assists in identifying, defining, and functioning within current software processes (i.e., Craneware, EPIC); review and/or development of reports and audit tools to support the requirements for revenue integrity and outcomes measurement.
8. Performs audits with a focus on revenue cycle integrity, assists in the development and implementation of charge practices and conducts root-cause analyses with Revenue Integrity Analysts to identify opportunities for error reduction.
9. Tracks and monitors key revenue cycle performance indicators; reports key findings to appropriate leadership and stakeholders across the organization.
10. Manage the performance and productivity of the team as it relates to CDM maintenance and charge capture processes.
11. Consistently complete performance monitoring processes and implement corrective actions as required.
12. Ensure revenue integrity and clinical department staff comply with established Revenue Integrity/Revenue Cycle policies, processes and quality assurance programs.
13. Support rollout of process improvements through the charge capture functions.
14. Maintain up-to-date knowledge of regulatory and compliance changes impact the CDM, charging requirements and operations and ensure revenue integrity and charge champion and service line leaders are appropriately educated and the CDM charging tools and processes are modified as need to capture revenue for services rendered.
15. Proactively works with department leaders to provide education as it pertains to changes in charge capture in accordance with local/nation and payor guidelines.
16. Effectively and professionally communicates results, challenges and solutions through daily interaction, regular reports, and monthly status meetings with Corporate Director of Revenue Integrity/Denials Management and/or Executive Director of Revenue Cycle.
17. Completes special projects, as directed by the Corporate Director of Revenue Integrity/Denials Management and/or Executive Director of Revenue Cycle; provide other support as needed.
18. Leads the Revenue Analyst team by providing feedback, constructive critique of work and job performance, and plans and organizes the functions and activities of the team to ensure department and corporate goals are met.

Develops and maintains effective relationships and communications with leaders, technical/application teams and external customers.Responsible for Epic Resolute HB/PB and Resolute HB/PB Claims, as well as other related billing applications.21. Prepare and execute functional system and program specifications using structured methodology.

22. Serve as a subject matter expert on assigned project teams and department initiatives, develop test scripts, conduct testing, support application upgrades and project go lives.

Utilize advanced application & analytic skills to design, build and test solutions to meet the needs of the organization.

EDUCATION REQUIRED/PREFERRED:

• Bachelor’s degree in business/accounting/finance or healthcare/business administration required
• Master’s degree preferred

Applicable clinical or professional certifications and licenses desirable.

HFMA, AAPC, CPC, CRCR preferred

EPIC HB/PB Certification preferred.

EXPERIENCE REQUIRED/PREFERRED:

• Ten or more years of hospital/clinic-based revenue cycle experience focused on revenue integrity and compliance.
• Five or more years of hospital-based billing, coding, and charge capture experience. Proficient knowledge of charge master components) CPT codes, HCPCs, Revenue Codes, GL and cost Centers.
• Charge capture, billing, or coding experience to include pharmacy, radiology, surgery/anesthesia, outpatient clinic, and inpatient hospitalization.
• Five or more years of EPIC PB and HB experience
• Partner with Patient Financial Services, Finance, Compliance, Information Services, and other departments on revenue management initiatives and strategic planning.
• Maintains current knowledge in present areas of responsibility (i.e., ongoing educational programs, self-education, etc.).
• Certification in CCA, CCS, CHC, CDIP, CMAS, or RHIT a plus.

KNOWLEDGE, SKILLS and COMPETENCIES REQUIRED/PREFERRED:

Technical Competencies:

• Excellent quantitative, analytical, critical thinking and organizational skills.
• Must have a team-oriented work ethic, strong interpersonal skills and the ability to professionally present and articulate information at all levels of the organization.
• Requires detailed knowledge of the charge capture and operational processes related to revenue cycle and medical records.
• Leads organization wide revenue cycle review and education and seeks opportunities to improve department and inter-department processes as it related to revenue cycle capture.
• Experienced with Epic, Craneware and Advanced reporting tools, Power BI etc.
• Excellent computer skills, including proficiency in Microsoft Office Suite, Teams and Zoom.
• Demonstrated knowledge of CMS regulations, OIG compliance, state Medicaid and third-party requirements and maintains compliance with regulatory requirements related to appropriate charge capture and charge reconciliation for all areas of the organization.
• In-depth knowledge of revenue codes, CPT/HCPCS Level II codes, billing, and coding edits (i.e., CCI, OCE, and MUE), and billing and reimbursement practices.
• Proficiency in payment review systems, hospital information systems, and coding methodologies.
• Ability to successfully multi-task effectively.