Revenue Integrity Manager

Essential Functions

• Revenue Integrity and Revenue Optimization: Develop and maintain a comprehensive revenue integrity program across behavioral health, substance use disorder treatment, crisis services, residential treatment, withdrawal management, and medical services; identify, quantify, and reduce revenue leakage throughout the revenue cycle; monitor revenue cycle performance indicators and trends; analyze missed billing opportunities, write-offs, denials, underpayments, and documentation deficiencies; partner with clinical and operational leaders to improve revenue capture while maintaining regulatory compliance; and evaluate payer reimbursement methodologies and identify opportunities for optimization.
• Documentation and Coding Compliance: Conduct routine documentation audits to ensure compliance with payer and regulatory requirements; review services for documentation completeness, medical necessity, timeliness, and billing readiness; monitor coding accuracy and consistency across programs; collaborate with providers and supervisors to improve documentation quality; and provide education regarding billing requirements, coding updates, and regulatory changes.
• Authorization and Utilization Oversight: Monitor authorization utilization and service delivery against approved units; identify services at risk for denial due to authorization, eligibility, or documentation issues; collaborate with utilization review and clinical teams to maximize authorized service utilization; and monitor payer-specific requirements and communicate changes to operational leaders.
• Denials and Payment Integrity: Analyze denial trends and root causes; develop corrective action plans to reduce denials and improve first-pass claim acceptance; partner with billing teams to resolve systemic denial issues; monitor underpayments and payer reimbursement accuracy; and support appeals and recovery efforts when appropriate.
• Revenue Cycle Analytics: Develop and maintain dashboards and reports related to utilization, productivity, documentation timeliness, open encounters, authorization utilization, denials, clean claim rate, days in accounts receivable, and revenue leakage; present findings and recommendations to leadership teams; and support budgeting, forecasting, and financial planning efforts.
• Cross-Functional Collaboration: Serve as a liaison between Clinical Operations, Revenue Cycle, Compliance, Quality, Information Technology, and Finance; lead revenue integrity workgroups and improvement initiatives; and support implementation of new services, billing rules, payer requirements, and workflows.
• Regulatory Compliance: Maintain knowledge of Oregon Medicaid (OHP) requirements, Coordinated Care Organization (CCO) requirements, Medicare regulations, commercial payer policies, behavioral health billing regulations, and federal and state compliance requirements; support internal and external audits; and assist with corrective action planning and monitoring.

Educational and/or Experience Requirements

• Bachelor’s degree in Healthcare Administration, Finance, Business Administration, Public Health, Accounting, Nursing, Behavioral Health, or related field.
• Five (5) years of experience in healthcare revenue cycle, compliance, coding, clinical operations, or related field.
• Three (3) years of experience analyzing healthcare financial and operational data.
• Experience working with Medicaid and behavioral health reimbursement models.

Licenses and Certifications

• Must maintain a valid Oregon Driver License or ability to obtain one upon hire, and be insurable under the organization’s auto liability coverage policy.
• Professional certification such as CHFP, CPC, CPMA, CRCR, or HFMA certification preferred.

Prioritized Skills

• Advanced understanding of healthcare revenue cycle operations.
• Knowledge of behavioral health documentation and billing requirements.
• Strong analytical, critical thinking, and problem-solving skills.
• Ability to translate complex financial and regulatory information into actionable recommendations.
• Strong project management and process improvement skills.
• Proficiency with Excel, reporting tools, data visualization platforms, MS Office 365, databases, virtual meeting platforms, internet, and ability to learn new or updated software.
• Excellent communication and presentation skills, including oral and written communication.
• Strong interpersonal and customer service skills.
• Strong organizational skills and attention to detail, accuracy, and follow-through.
• Excellent time management skills with a proven ability to meet deadlines.
• Ability to maintain strict confidence as required by HIPAA, 42 CFR, and Oregon statutes.
• Ability to build and maintain positive relationships.
• Ability to function well and use good judgment in a high-paced and at times stressful environment.
• Ability to manage conflict resolution and anger, fear, hostility, or violence of others appropriately and effectively.
• Ability to work effectively and respectfully in a diverse, multi-cultural environment.
• Ability to work independently as well as participate as a positive, collaborative team member.