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

About the Role

This is a remote, full-time position providing leadership and day-to-day operational management for the revenue integrity functions of local hospital(s) and/or Medical Group Provider Services (MGPS). The role focuses on preventing revenue leakage, maximizing potential revenue, and optimizing staff performance through process redesign, policy implementation, and professional development. The position involves managing the Charge Description Master (CDM), pre-bill edits, root cause analysis, denials coordination, audits, and education for multi-disciplinary teams.

Responsibilities

• Incorporate and demonstrate the organization’s mission, vision, and values in daily behaviors and decisions.
• Collaborate with Revenue Integrity and Payer Strategies leadership to ensure understanding and application of payer contracts.
• Monitor Medicare, Medicaid, and other payer websites for regulatory changes impacting charging, coding, and billing; ensure compliance and revenue optimization.
• Manage denials coordination with Patient Business Service (PBS), ensuring timely resolution and root cause analysis; participate in multi-disciplinary denial teams.
• Perform root cause analysis on denials and pre-bill edits; collaborate with inter- and intra-departmental teams to implement process improvements.
• Prepare and conduct educational sessions for departments and staff on audit findings, regulatory changes, coding updates, and billing requirements.
• Develop colleague work schedules to ensure cost-effective staffing that meets customer and quality performance requirements.
• Manage team projects, foster collaborative relationships, and promote active participation across departments.
• Elicit feedback from interdisciplinary teams, including medical staff, and involve them in decision-making.
• Ensure problem resolution and corrective action for long-term solutions through inter- and intra-departmental coordination.
• Assess developmental needs of the department and promote opportunities for professional growth and independent decision-making.
• Identify and implement opportunities for colleagues to enhance their knowledge and professionalism through orientation and continuing education.
• Hire employees, allocate resources, conduct performance appraisals, and manage ongoing feedback; may terminate positions as necessary.
• Provide prompt, direct, and positive feedback; mentor and coach colleagues to ensure positive outcomes.
• Analyze and display data in meaningful formats; develop and communicate policies, procedures, and management reports, including Key Performance Indicators.
• Maintain knowledge of applicable federal, state, and local laws, as well as organizational compliance programs and policies.
• Perform other duties as assigned.

Requirements

• Bachelor’s degree in Finance, Business Administration, or a 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 experience.
• Minimum of three years of management experience in a multi-facility, integrated healthcare delivery system or revenue cycle/revenue integrity consulting.
• Strong understanding of appeals, denial management, medical necessity, and coding audits; ability to read medical charts and correlate services to charges on UB and 1500 claim forms.
• Experience with Charge Description Master (CDM) maintenance or oversight preferred.
• Ability to organize, plan, and manage staff in revenue integrity and optimization activities for a large healthcare organization.
• Knowledge of laws and payer contracts governing hospital and/or physician services billing.
• Demonstrated ability to work effectively with diverse groups, including physicians, clinicians, administrators, and third-party payers.
• Ability to interpret complex issues, clinical processes, and recommend improvements.
• Experience with data collection, analysis, and written reports incorporating findings.
• Strong knowledge of Diagnosis Related Group (DRG), Ambulatory Payment Classification (APC), Outpatient Prospective Payment System (OPPS), and pre-bill edits including OCE/CCI edits and Discharged Not Final Billed (DNFB).

Qualifications

• Licensure/Certification: RHIA, RHIT, CCS, CPC/COC, or other coding credentials preferred.
• CDC (Healthcare Compliance Certification) preferred.

Pay

Salary Range: $42.2592 - $63.3888 per hour.

Physical and Mental Requirements

• Operates in a typical office environment with controlled temperature and lighting.
• Frequent communication, both in-person and over the phone, with diverse teams.
• Manual dexterity required for keyboard operation.
• Ability to concentrate, meet deadlines, and manage multiple projects simultaneously in a potentially stressful environment.
• Must adapt to frequent changes in workload and priorities.
• May require varied or extended hours to meet industry demands and strategic priorities.