Manager of Revenue Integrity Compliance

Responsibilities

• Develop, implement, and manage the Revenue Integrity & CDM Compliance Plan.
• Ensure compliance with CMS Price Transparency Rule and other applicable federal and state financial reporting regulations.
• Collaborate with cross-functional teams including Health Plan Operations, Patient Access, Marketing, IT, and Legal to streamline compliance processes.
• Design and execute weekly/monthly audit plans for compliance-related reporting activities.
• Coordinate with hospital end users and offshore teams to ensure accurate and timely deliverables.
• Lead the development and implementation of process automation tools to enhance compliance efficiency.
• Generate and distribute weekly/monthly compliance reports to stakeholders.
• Monitor regulatory changes and update internal policies and procedures accordingly.

Qualifications

• Bachelor’s degree in Healthcare Administration, Finance, or a related field of study is required (Combination of education and experience is also acceptable).
• Minimum seven (7) years of experience in healthcare revenue cycle operations is required.
• Minimum three (3) years of experience in leading a revenue cycle function is required.
• Prior experience in interpreting different claim forms and remittances is required.
• Understanding of patient insurance benefit is required.
• Experience working with payers including Medicare, Medicaid, and commercial insurance is required.
• Understanding of CPT’s, HCPCs, Diagnosis code, DRG code, EAPG, revenue code, etc. is required.
• Understanding of payor payment methods viz. Fee Schedule, RCC, Case rate is required.

Preferred Qualifications

• Experience working with Contract Management and Patient Access is preferred.
• Prior experience working with EPIC and Meditech preferred.

Pay and Benefits

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $97,760.00 to $141,440.00 on an annualized basis. The compensation estimate noted above is specific to California and has not been adjusted for any other geographic location. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.