Medical Revenue Manager | Remote

Key Responsibilities

• Evaluate model-generated charge review outputs, coding recommendations, and revenue integrity alerts against CMS billing guidelines, Medicare Part A/B rules, and payer-specific requirements, documenting accuracy and compliance gaps with structured annotations.
• Conduct charge audits across clinical departments to detect missed charges, duplicate submissions, and capture errors; develop and track corrective action plans through resolution.
• Manage and maintain the charge description master (CDM), ensuring integrity of charge codes, revenue codes, and pricing in alignment with regulatory requirements.
• Analyse charge patterns to surface revenue leakage opportunities and implement targeted remediation strategies with measurable KPI outcomes (charge lag, capture accuracy, revenue integrity findings).
• Provide structured written feedback on model outputs to support training dataset development, translating compliance expertise into actionable annotation.
• Ensure ongoing adherence to CMS billing guidelines, OIG work plan priorities, and institutional compliance frameworks across all charge capture functions.

Core Requirements

• Demonstrated expertise in charge capture workflows, charge integrity operations, and revenue integrity analysis within hospital, health system, or physician group environments.
• Comprehensive knowledge of CDM management, revenue code assignment, and billing compliance including Medicare Part A/B rules and OIG compliance requirements.
• Proficiency with EHR platforms, charge capture systems, and revenue integrity tools; able to navigate and assess outputs from multiple systems simultaneously.
• Prowess in conducting charge audits and designing corrective action plans that improve capture accuracy and reduce compliance exposure.
• Proven track record in providing structured written feedback on model outputs to support training dataset development, translating compliance expertise into actionable annotation.
• Exceptional written English communication skills, with the ability to produce precise, well-organised documentation suitable for compliance and training purposes.
• High analytical precision in identifying billing errors, coding inconsistencies, and compliance risks within complex, high-volume charge data.

Additional Strengths

• Active CPC, CCS, CHFP, or CRCS credential demonstrating formal billing and coding credentialing.
• Familiarity with 340B drug program charge capture requirements and associated compliance considerations.
• Comfort evaluating automation-generated billing and coding content, with experience using revenue integrity analytics platforms.