Manager Revenue Integrity & Optimization - Acute/Professional (Remote)

Work Remote Position

About the role

Provides leadership and day-to-day operational management and direction for the local hospital(s) and/or Medical Group Provider Services (MGPS) revenue integrity functions. Responsible for motivating staff to achieve the highest levels of performance, working in conjunction with all key stakeholders to prevent revenue leakage and maximize potential revenue for the region.

Manages Charge Description Master (CDM), pre-bill edits, root cause analysis, denials coordination with PBS, including complex case denials, denial prevention, audits, and education and training of multi-disciplinary hospital and/or MGPS teams. Manages revenue optimization opportunities which may include charge control processes.

Responsible for optimizing staff and overall revenue performance through process redesign, policy/procedure implementation, communications, continuing education and professional development activities, staff empowerment and feedback.

Responsibilities

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
• Works with Revenue Integrity and Payer Strategies leadership to ensure understanding of payer contracts, application of contract terms and ensures alignment with processes.
• Monitors Medicare and Medicaid websites, as well as other payer websites and newsletters for changes impacting charging, coding, and billing. Manages the process to apply updates and ensure compliance and revenue optimization.
• Manages the coordination of denials received from Patient Business Service (PBS) center; ensures staff timely resolution and identification of denials' root cause. Works with PBS and other Revenue Integrity leaders to create and participate in ongoing multi-disciplinary denial team.
• Manages and may perform the root cause analysis on denials and pre-bill edits and collaborates with inter and intra-departmental teams to implement process and/or identify system intersection opportunities to address cause and optimize revenue.
• Prepares and conducts educational services to departments and staff pursuant to audit findings, regulatory changes and requirements, coding updates, and managed care billing requirement changes.
• Manages the development of colleague work schedules to ensure cost-effective staffing that meets customer requirements and quality performance.
• Manages team projects, fosters interdisciplinary and intra-department collaborative relationships, and promotes active participation.
• Elicits feedback from interdisciplinary team, including the medical staff, and involves them in decision-making as appropriate.
• Ensures problem resolution and corrective action for long-term solution, coordinating such effort across the intra and inter-departmental channels.
• Formally assesses the developmental needs of the department on a periodic basis and promotes opportunities for development in independent decision-making, effective communications, and interpersonal relations to ensure customer satisfaction.
• Identifies and implements opportunities for colleagues to increase knowledge base, advance practice, and enhance professionalism through colleague orientation and continuing education opportunities.
• May manage some degree of training to meet goals.
• Responsible for hiring employees and allocation of resources based on scope of goals and priorities.
• Monitors and conducts performance appraisals, including review and approval of performance goals, manages regular ongoing performance feedback, and may terminate positions when necessary.
• Provides feedback in a prompt, direct, and positive manner; mentors and coaches colleagues to ensure positive outcomes.
• Provides counseling and/or conflict resolution regarding unresolved performance issues, demonstrating effective use of the disciplinary process.
• Analyzes and displays data in meaningful formats; develops and communicates policies/procedures and other business documentation; manages and conducts special studies and prepares management reports, including Key Performance Indicators as they relate to the department.
• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
• Other duties as assigned.

Requirements

• Bachelor's degree in Finance, Business Administration, or related field.
• Minimum of five to seven years of progressively responsible experience in revenue cycle operations, including revenue integrity, or equivalent combination of education and progressive revenue cycle experience.
• Minimum of three years of management experience in a multi-facility, integrated health care delivery system or revenue cycle or revenue integrity consulting experience.
• Knowledge and experience in revenue integrity at an acute and/or physician practice.
• Strong understanding of appeals, denial management, medical necessity, and coding audits with ability to read medical charts and dictation and correlate services to charges on the claim forms (UB and 1500).

Qualifications

• Licensure/Certification: RHIA, RHIT, CCS, CPC/COC, or other coding credentials preferred.
• CDC (Healthcare Compliance Certification) preferred.
• Experience in Charge Description Master (CDM) maintenance or oversight preferred.
• Ability to organize, plan, and manage staff in Revenue Integrity and Optimization activities of a large healthcare acute and professional billing organization.
• Knowledge of laws and payer contracts governing billing of hospital and/or physician services.
• Demonstrated ability to work effectively with a diverse group of people including physicians, clinicians, office managers, administrators, third-party payers, governmental agencies, and colleagues.
• Ability to understand and interpret complex issues and clinical processes and recommend improvements.
• Experienced with data collection, analysis, and providing written reports, proposals incorporating findings.
• Ability to read medical charts and dictation, understand services performed, and correlate those services to charges on the claim forms (UB and/or 1500 forms).
• Strong knowledge of Diagnosis Related Group (DRG), Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and pre-bill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Not Final Billed (DNFB).

Pay

Salary Range: $42.2592 - $63.3888 per hour.

Physical and Mental Requirements

• Operates in a typical office environment that is well lit, temperature-controlled, and free from hazards.
• Communicates frequently, in person and over the phone, with people in all locations on product support issues.
• Manual dexterity needed to operate a keyboard.
• Hearing needed for extensive telephone and in-person communication.
• Ability to concentrate, meet deadlines, work on several projects at the same time, and adapt to interruptions.
• Must be able to set and organize own work priorities and adapt to them as they change frequently.
• Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
• Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful.
• May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities.