Manager of Revenue Integrity Full Time

Position Responsibilities

• Manages relationship with Contract Management vendor across all entities
• Works closely with all data owners to ensure claims and reimbursement data are loaded to Contract Manager in a timely and accurate manner
• Trains new and existing staff members on Contract Management applications
• Ensures applications are utilized effectively and consistently by the teams to achieve the desired outcomes related to optimal reimbursement
• Reviews and analyzes payor EOBs, network plans, patient ID cards, and member benefits to identify variance in claim data
• Develops and maintains all standard and ad hoc reporting using Contract Management System across all entities
• Develops and maintains standard set of KPI’s to measure contract and staff performance & compliance
• Develops and maintains Payor Contract Scorecards to ensure contract compliance and payor performance
• Analyzes provider and facility claims data to identify trends, issues and recovery opportunities
• Takes leadership role in planning, developing, implementing and evaluating revenue integrity projects
• Provides and presents executive summary presentations (Dashboards) which may include monthly reports in achieving outcomes in the areas of work volume, staff performance, payor performance, contract performance
• Creates and implements policies and procedures to promote effective appeals and recoveries processes and revenue cycle operational effectiveness
• Determines performance objectives/metrics and defines tools to measure progress and ensures consistent achievement of business objectives for the department

Requirements

• Experience: Five (5) years’ experience working in the healthcare field
• Understanding end-to-end revenue cycle management functions
• Understanding appeals and recoveries processes
• Workflow and outcomes management

Preferred

• Leading and motivation a team required with CMS Coding and Billing experience

Education

• Required: Associates degree or extensive experience (greater than 5 years) in reimbursement methodologies, billing and coding
• PREFERRED: Bachelor’s Degree Healthcare realm

Special Qualifications

• Valid Driver’s License and satisfactory motor vehicle record (MVR) may be required
• Annual MVR may be required per policy and procedure; background reports may be ran as needed throughout the course of employment
• Must be proficient in use of Microsoft Office Suite, with emphasis on Excel
• Must have excellent communication skills both oral and written
• Must demonstrate professional judgement in work assigned and be able to multi-task