Program Manager Revenue Integrity

About the role

As a Program Manager for Revenue Integrity, you will offer subject-matter expertise within internal revenue cycle systems to ensure efficient and compliant research patient billing practices across the Service Area of responsibility. You will collaborate with research revenue producing departments, revenue integrity teams, Optum 360 personnel, information systems personnel, and technical and clinical personnel to identify research chargeable activities, establish charge capture mechanisms, and properly code (or add modifiers) research charges for timely and accurate recording of research claim related revenue consistent with research regulations, state and federal requirements. You will also manage research patient charge revenue cycle, oversee charge reconciliation procedures, review research claim denials, and develop corrective action plans.

Responsibilities

• Establish collaborative working relationships with research revenue producing departments, revenue integrity teams, Optum 360 personnel, information systems personnel, and technical and clinical personnel to identify research chargeable activities, establish charge capture mechanisms, and properly code (or add modifiers) research charges for timely and accurate recording of research claim related revenue consistent with research regulations, state and federal requirements.
• Develop training plan to educate all stakeholders, including research personnel and coders on necessary chart documentation of research related services to ensure clinical documentation validates research billable charges.
• Responsible for development of quarterly chart documentation review(s) plan and preparation of summary report findings to share with department leadership across divisions to improve revenue recovery.
• Manage research patient charge revenue cycle beginning with management of Medicare Cost and Coverage Analysis Worksheet (MCCAW) personnel required to translate MCCAW into research patient billing grid to identify billable versus non-billable research charges. Integrate research revenue workflows and needs across preauthorization, registration, charge-capture, charge-review and adjudication teams to ensure compliant claim distribution.
• Oversee charge reconciliation procedures including research claim holds, movement of charges and quality control methods for release within established timelines. Review research claim denials and develop corrective action plan(s) related to any deficiencies noted concerning research charge capture effectiveness and system integration.
• Work includes development and oversight of ancillary service provider agreements and invoice methodologies.
• Develops and implements research Quality Assurance/Quality Control methodologies into operational workflow. This includes evaluation and identification of root causes resulting in deficiencies or lack of revenue recognition. Translate findings into action to minimize revenue at risk while identifying research charge trends and audit needs to improve service and ensure regulatory compliance throughout research revenue cycle.
• Serve as primary point of contact for all matters related to research revenue integrity with decisional authority to develop and distribute policies, work instructions and procedures necessary for efficient, effective and compliant workflows. Works synergistically with internal/external departments involved in the research revenue cycle. Maintains personal professional growth and development through seminars, workshops and professional affiliations. Establishes goals and objective for direct reports and guides cross-functional teams on transactional processing needs.
• Provides employees access to resources needed to advance subject matter expertise with a synergistic approach to training and process improvement plans.
• Identify automation opportunities across software systems such as Cerner EMR, Clinical Trial Management System, Lawson, and various other coding and billing software systems in use within the assigned Service Area. Determines data sources necessary to establish data report information to continually review and recognize clinical research revenue opportunities. Initiate revenue report generation methodologies and stakeholder distribution lists to share research revenue charge trends and research revenue volume.

Requirements

• Bachelor's degree or a combination of education and /or additional job related experience may be substituted in lieu of the degree
• Three (3) years of revenue cycle experience including billing, coding and charge capture and two years of supervisory/management experience

Preferred

• Masters Degree
• Five (5) years of revenue cycle leadership and/or clinical trial billing experience
• Certified Coding Associate or Certified Coding Specialist or Certified Professional Coder