Manager Revenue Integrity (Remote)

Full-time, day shift position. This is a remote role.

About the role

Provides leadership and day-to-day operational management 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 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, including charge control processes. Optimizes staff and overall revenue performance through process redesign, policy/procedure implementation, communications, continuing education, professional development, staff empowerment, and feedback.

Responsibilities

• Knows, understands, incorporates, and demonstrates the organization’s 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 alignment with processes.
• Monitors Medicare, Medicaid, and other payer websites/newsletters for changes impacting charging, coding, and billing; manages the process to apply updates and ensure compliance and revenue optimization.
• Manages coordination of denials from Patient Business Service (PBS) center; ensures timely resolution and identification of root causes. Collaborates with PBS and other Revenue Integrity leaders to create and participate in ongoing multi-disciplinary denial teams.
• Performs root cause analysis on denials and pre-bill edits; collaborates with inter- and intra-departmental teams to implement process improvements or identify system opportunities to address causes and optimize revenue.
• Prepares and conducts educational services for departments and staff regarding audit findings, regulatory changes, coding updates, and managed care billing requirement changes.
• Manages development of colleague work schedules to ensure cost-effective staffing that meets customer requirements and quality performance.
• Manages team projects, fosters interdisciplinary and intra-departmental collaborative relationships, and promotes active participation.
• Elicits feedback from interdisciplinary teams, including medical staff, and involves them in decision-making as appropriate. Ensures problem resolution and corrective action for long-term solutions across intra- and inter-departmental channels.
• Assesses developmental needs of the department periodically 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 orientation and continuing education.
• Responsible for hiring employees, allocating resources based on goals and priorities, conducting performance appraisals, managing ongoing performance feedback, and terminating positions when necessary.
• Provides prompt, direct, and positive feedback; mentors and coaches colleagues to ensure positive outcomes. Provides counseling and/or conflict resolution regarding unresolved performance issues.
• 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.
• Maintains working knowledge of applicable Federal, State, and local laws and regulations, organizational integrity and compliance programs, and code of conduct to ensure adherence.
• Other duties as assigned.

Requirements

• Bachelor’s degree in Finance, Business Administration, or related field, plus a minimum of 5–7 years of progressively responsible experience in revenue cycle operations, including revenue integrity, or equivalent combination of education and experience.
• Minimum of 3 years of management experience in a multi-facility, integrated healthcare delivery system or revenue cycle/revenue integrity consulting.
• Knowledge and experience in revenue integrity at an acute and/or physician practice level.
• 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 claim forms (UB and 1500).
• 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.
• Experience 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 claim forms (UB and/or 1500 forms).
• Strong knowledge of Diagnosis Related Group (DRG), Ambulatory Payment Classification (APC), 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: $42.26–$63.39 per hour.

Physical and Mental Requirements

• Operates in a typical office environment: well-lit, temperature-controlled, and free from hazards.
• Frequent communication (in person and by phone) with people in all locations on product support issues.
• Manual dexterity required for keyboard operation.
• Hearing required for extensive telephone and in-person communication.
• Ability to concentrate, meet deadlines, work on multiple projects simultaneously, and adapt to interruptions.
• Must organize own work priorities and adapt to changing priorities in a fast-paced, multi-customer environment with conflicting needs, which may be stressful.
• May require varied and/or extended hours with changes in workload and priorities to advance strategic goals.