Manager Revenue Integrity

Job Summary

The Revenue Integrity manager provides management planning, development and guidance to staff within the roles of Audit and Chargemaster. They analyze data, develop an overall approach for trending issues, report findings, apply timely and constructive feedback, continue education and training for Revenue Integrity, clinical departments, nursing units/depts. They prepare departments summaries based upon audit findings and work closely with applicable staff/management for continued performance improvement ensuring compliance with Medicare/Medicaid regulations, Managed Care contractual agreements and the applicable policies of UT Southwestern University Hospital.

Benefits

UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include: PPO medical plan, available day one at no cost for full-time employee-only coverage; 100% coverage for preventive healthcare-no copay; Paid Time Off, available day one; Retirement Programs through the Teacher Retirement System of Texas (TRS); Paid Parental Leave Benefit; Wellness programs; Tuition Reimbursement; Public Service Loan Forgiveness (PSLF).

Required Experience and Education

• Bachelor's Degree from a recognized college or university in business, healthcare or a closely related field
• 10 years' of experience within the revenue cycle and coding
• Experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: coding, charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management or Audit Nursing
• 1 year Supervisory experience
• Licenses and Certifications (RN): REGISTERED NURSE or (CPHT): CERT PHARMACY TECH or (PTCB): CERT COMPND STERILE PREP TECHN or (CHRI): CertHealthcareRevenueIntegrity professional certification through NAHRI or (RHIA): REGD HEALTH INFO ADMINIST professional certification through AHIMA or (RHIT): REGD HEALTH INFO TECHNOLOGIST professional certification through AHIMA or (CCS): CERT CODING SPECIALIST professional certification through AHIMA or (COC): Certified Outpatient Coding professional certification through AAPC or (CPC): CERT PROFESSIONAL CODER professional certification through AAPC

Preferred Experience

• EPIC HB/PB experience
• Project Management and Six Sigma Green Belt knowledge/experience

Job Duties

• Oversees all revenue integrity staff with a focus on charge capture and charge reconciliation activities
• Covers efforts with Sr. Nurse Auditor and Sr. Chargemaster Coordinator to lead audit/charge evaluations according to RI auditing guidelines
• Mets with departmental leadership to review findings, documentation standards and recommendations for improvement
• Targets populations through random sampling, focused reviews, issues identified in collaboration with various site personnel, and rotation/selection of specific clinical areas
• Audits include review of selected medical records documentation to determine accuracy of coding assignments, billing compliance, medical necessity and when appropriate collaborates with shared coding and financial departments to identify departments that require improved documentation
• Coordinates efforts with Sr. Nurse Auditor and Sr. Chargemaster coordinator to ensure all staff are informed of all regulatory changes for both hospital billing and professional billing, conducts any necessary training and all policies are kept up to date assists departments with the charge reconciliation process
• Works with all relevant hospital departments and professional billing departments to provide timely education on how to correct or improve processes that have been found to be deficient
• Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections for both hospital and professional billing
• Stays abreast of ongoing compliance trends and developments. Reports new developments to department. Plans and presents in-services to nursing, physician, and other clinical personnel regarding processes, updates and reviews relating to audit findings and/or regulatory compliance

Security and EEO Statement

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information. UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.