Manager Professional Revenue Integrity

Job Summary

This position is responsible for overseeing and managing all aspects of professional charge functions to ensure the integrity of the organization’s revenue. This role effectively summarizes findings to support the development of processes and procedures, demonstrating awareness of financial implications of decisions and business impact.

Job Description

• Education: High School Diploma required. Bachelor’s degree in Healthcare Administration, Business Administration, Accounting or related field preferred.

• Licenses/Certifications: Certification(s) preferred: Certified Professional Coder (CPC), Certified Medical Coder (CMC), Epic certification such as ARCR: Resolute Professional Billing Claims and Billing Readiness, Project Management Professional (PMP).

• Experience / Knowledge / Skills: Five (5) years of Physician/Professional Billing experience required. Three (3) years in a management or supervisory level position for a large health system preferred. Extensive knowledge and experience with Epic EMR system, specifically with EPIC Resolute Billing with a large health system. Experience in Charge Capture, Charge Reconciliation, and Charge Pricing. Comprehensive understanding of healthcare billing and coding systems (e.g., HCPCS, ICD-10). Supervisory and mentoring skills necessary to provide support to department and promote employee development. Advanced proficiency in Microsoft Excel and other Microsoft Business applications (i.e. Word, PowerPoint). Strong communication skills and ability to successfully collaborate with team members across the organization at all levels. Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action. Ability to supervise and train employees, including organizing, prioritizing, and scheduling work assignments to meet timelines. Ability to collaborate and address problems in an organized manner involving multiple variables within the scope of the position. Ability to make independent decisions when circumstances warrant; make prompt and accurate judgments regarding other job duties.

Principal Accountabilities

• Manages all facets of professional revenue integrity processes to achieve and exceed best practice benchmarks. Serves as liaison between revenue cycle and clinical departments. Contributes to the organization's financial performance by implementing process enhancements, optimizing charge capture and reconciliation, and maximizing revenue to achieve optimal reimbursement for services rendered.

• Maintains a thorough comprehension of revenue cycle processes including Charge Capture, Charge Reconciliation, Data Analytics, Pricing and Professional Billing. Collaborates with Revenue Cycle, Clinical Departments, and Finance is essential to ensure accurate revenue capture, compliance, and optimization. Supports the ongoing integrity of charge activity inclusive of technical and operational workflow and functionalities.

• Maintains current working knowledge of billing systems, claim submission, remittance advices, explanation of benefits, reimbursement methodology, payer systems, payer requirements, general coding, APC, CPT and HCPCs. Monitors daily reconciliation reports to assist departments in maintaining accurate and timely charges. Reviews analyses, reports, KPIs, and operational metrics. Participates in corrective actions in response to variances and trends. Utilizes a data-driven approach to prioritize actionable improvements resulting from root cause denial analysis, promoting prevention and error reduction involving assessment of system edits, provider education, and clinic management feedback.

• Sets a positive example in collaborating initiatives, identifying solutions, measuring, and sharing results and providing specific feedback. Oversees management of appropriate personnel, providing recommendations for hiring, promotion, salary adjustment and personnel action. Manages staffing levels and productivity. Provides team communication regarding department updates, organizational activities, financial performance, educational opportunities, interdepartmental activities, and QI activities. Ensures the recruitment, training, and retention of motivated, competent revenue integrity analysts; establishes goals and standards for performance appraisals. Provides, oversees, and/or coordinates the provision of training for new and existing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques. Guides individuals and groups toward desired outcomes, setting performance standards and delivering leading quality services. Complies with HIPAA and all relevant laws, rules regulations and accreditation standards and requirements. Adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity, and quality of service. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff. Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce. Other duties as assigned.