Manager - Revenue Integrity Operations

About the role

This position contributes and supports Revenue Integrity’s Mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and charge improvement process. It is a holistic approach that guides the MaineHealth organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. Under the direction of the Director of Revenue Integrity, the Revenue Integrity Manager plays an important role in a high-profile group tasked with improving revenue results. This position is integral to the Revenue Integrity Team to assist in ensuring patient services are accurately charged, appropriately coded, supported by clinical documentation and that the related revenue is recorded in the proper department. In turn, this promotes revenue enhancement and compliance with laws and regulations with feedback and education to the hospital departments as needed.

Responsibilities

• Monitoring and supporting revenue integrity processes, productivity measures and staff functions
• Aiding in ensuring the accuracy and integrity of the revenue charge capture across the health system
• Collaborating with team members to steer projects related to charge capture for financial success

Requirements

Education: Bachelor’s degree from a recognized college or university in business, healthcare or a closely related field or seven to ten (7-10) years of supervisory and/or leadership experience within the revenue cycle in lieu of education.

License/Certifications: COC, CPC, CCS certification required, or must obtain within 6 months of employment to the position.

Experience: Seven to ten (7-10) years’ experience in the hospital setting, healthcare industry with proven proficiency or past experience in a management position in the following areas: charge integrity; charge reconciliation; charge compliance; project and performance management, productivity measures with performance outcomes. Capacity to review, analyze and interpret data and analytics to root cause and implement corrective action. EPIC HB/PB experience preferred.

Proficiencies: Extensive knowledge of revenue cycle processes and hospital/medical billing to include CDM, UB, RAs and 1500. Extensive knowledge of code data sets to include CPT, HCPCS, and ICD 10. Extensive knowledge of NCCI edits, and Medicare LCD/NCDs. Extensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Strong understanding of billing guidelines and state and federal regulations with impact analysis. Ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership and other billing or coding personnel.

Abilities: Requires the ability to manage large complex projects assignments, investigate, analyze and resolve issues at a high level. Excellent communication, presentation, organizational, analytical and problem solving skills. Must approach problem solving challenges independently, have strong attention to detail and enjoy working in a fast paced, collaborative team based environment. Computer skills - MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.

Benefits

• Paid parental leave
• Flexible work options
• Student loan assistance
• Professional development opportunities
• Well-being resources

Pay

The pay range for this position is $83,324.80 to $112,736.00 per year.