Manager Revenue Integrity

About the role

ChristianaCare, with Hospitals in Wilmington and Newark, DE, as well as Elkton, MD, is one of the largest health care providers in the Mid-Atlantic Region. Named one of “America’s Best Hospitals” by U.S. News & World Report, we have an excess of 1,100 beds between our hospitals and are committed to providing the best patient care in the region.

Responsibilities

• Develops, implements, and oversees effective and consistent operational policies, processes, tools, and educational materials within PB Revenue Integrity functional areas.
• Serves as the operational lead for Epic PB enhancements, ensuring effective change management, communication, testing, and adoption of new functionality across clinical and administrative teams.
• Evaluates and optimizes Epic Charge Generation Tracker (CGT) configuration to support compliant charging, reduce denials, and support accurate pricing strategies.
• Owns the tactical framework for denial prevention related to charge capture, coding (when applicable), and payer edits; collaborates with PB Revenue Cycle Managers to operationalize sustainable root-cause solutions.
• Manages daily activities of revenue integrity areas. Audits unbilled work queues for root causes (pre-bill edits) and uncoded services.
• Provides guidance to revenue integrity analysts. Reviews detailed daily/weekly/monthly dashboard reports for each entity, including work queue volumes, denial trends and key performance indicators, and takes appropriate action to ensure department/organizational goals are being met.
• Builds and maintains a close relationship with payer provider representatives to ensure proper claim processing.
• Maintains comprehensive knowledge of regulatory requirements related to third party billing rules.
• Responds to inquiries with regards to CMS policies, third party payer guidelines, and billing department protocols.
• Reviews communications received from third party payers and shares information with impacted personnel.
• Prepares and revises policies and procedures as warranted and conducts in-service/meetings with caregivers.
• Safeguards the integrity of billed accounts by ensuring compliance with billing, documentation, and coding standards.
• Attends, participates, and conducts departmental staff and management staff meetings.

Qualifications

• Bachelor’s degree in Healthcare Administration, Accounting, or Business. Relevant experience may be considered in lieu of a 4-year degree.
• Certified Professional Coder certification (CPC) required.
• Epic Revenue Cycle and Revenue Integrity experience preferred.
• Five years of work experience related to professional billing and coding with at least three years in a progressive management role.
• Proven experience of coding and billing requirements based on third party publications and contractual language, including Blue Shield, Medicare, Medicaid, commercial insurers and HMOs/PPOs and other governmental insurance plans.

Skills

• Proficiency with Epic Professional Billing (PB), including Charge Router, Charge Review work queues, Charge Capture workflows, and Charge Generation Tracker (CGT) configuration principles preferred.
• Ability to evaluate and adopt emerging technologies that support revenue integrity, denial prevention, and analytic insight.
• Demonstrated experience leading change management efforts, including workflow redesign, training, and stakeholder/employee adoption of new processes or system enhancements.
• Ability to interpret compliance requirements and apply them to operational workflows, documentation standards, and charging practices.
• Ability to cultivate and contribute to a culture of accountability, collaboration, and continuous improvement.
• Exceptional interpersonal skills, with the ability to communicate complex billing or regulatory concepts clearly to providers, executives, operational leaders, and frontline staff.
• Strong problem-solving abilities with the capability to make sound decisions in a fast-paced, high-volume, and complex environment.
• Strong working knowledge of regulatory requirements, payer requirements, billing and collection processes and functions, coding requirements (ICD-10, CPT, HCPCs, etc.), general revenue cycle management strategies, and industry best practices.
• Strong Knowledge of CMS regulations governing Medicare and Medicaid billing and reimbursement.
• Strong knowledge of medical record content and structure.
• Strong knowledge of state and federal laws governing billing.
• Strong knowledge of physician office procedures as related to billing.
• Ability to read and explain financial reports.
• Ability to effectively present information and respond to questions from various groups.
• Substantial knowledge of metrics, analytics, and data synthesis in healthcare revenue integrity and revenue cycle management to identify trends, produce reliable forecasts and projections.
• Ability to apply Human Resource policies and procedures for personnel actions.
• Ability to research and analyze charge and chart documentation.
• Strong written and verbal communication skills essential for explaining problems and recommending solutions.
• Strong working knowledge of Microsoft Office products (Word, PowerPoint, and Excel) as well as the Internet, for issue-related searches; ability to develop reports and create presentations.

Pay

Annual Compensation Range $92,726.40 - $148,387.20

Schedule

Full-time