REVENUE INTEGRITY MANAGER - REVENUE INTEGRITY
Status: Full Time
Shift: 40 hours per week
Provides supervision, leadership, workflow organization, and training for Revenue Integrity Specialist and Supervisor. Responsible for designing, monitoring, and maintaining charging process. All work must be completed timely and tactfully in a manner that is ethical and compliant and provides the basis for accurate bills.
1. Previous Experience:
Required: 5 years in revenue cycle or chart auditing or clinical care in a healthcare organization. 2 years of supervisory experience. Strong communication skills. Strong analytical skills. Strong organizational skills. Strong computer skills including Microsoft Word and Excel.
Preferred: Proficiency in Epic. Charging, HCPCS/CPT coding or billing experience within health system.
2. Specialized or Technical Education Required:
Required: Bachelor’s degree in business/healthcare/related field or high school diploma with 2 years healthcare experience for each year college not completed. Working knowledge of charging or coding or billing guidelines in healthcare setting.
Preferred: RN or LPN.
3. Manual or Physical Skill Required:
Proper vision, hearing, and body mechanics to operate computers, telephone, and other office equipment; to spend long hours sitting and working with computer; to occasionally walk between various departments; and to occasionally lift files or papers weighing up to 10 lbs.
4. Physical Effort Required/Physical Demands:
DESCRIPTION OF DUTIES:
1. Supervise and manage the area of Revenue Integrity operations, system processes, and procedures.
2. Monitor Revenue Integrity Specialist’s and Supervisor’s workload, productivity and performance. Ensure that all duties are completed accurately and timely.
3. Monitor hospital Candidate For Billing (CFB) and incomplete professional fee charging and maintain them at a minimum level.
4. Problem solve and assist Revenue Integrity Supervisor and Specialist in completing charges and edits. Prioritize high dollar/priority accounts.
5. Demonstrate responsiveness on matters requiring additional attention. Ensure outstanding matters are followed through completion.
6. Responsible for Revenue Integrity Specialists’ and Supervisor’s selection, evaluation, counseling, staff development, and training.
7. Develop and maintain appropriate standards, policies, and procedures for applicable areas.
8. Understand Medicare, Medicaid, and other Payors regulations and guidelines as related to coverage of services. Research and provide guidelines for accurate charge information and sufficient documentation.
9. Understand the relationship between proper documentation and charges and be able to link the charges on the account/claim with the documentation in the medical record. Assist in efforts and ensure resolution when discrepancies or deficiencies are identified.
10. Design, implement, and maintain audit process to identify charging risk areas. The primary goal is to improve the performance of charge capture process to include assisting in the development of best practices, coordinating error resolution, and establishing prevention measures. Compile information and/or prepare reports and analyses setting forth results of audits with appropriate recommendations.
11. Review audit result performed by Revenue Integrity Specialists to ensure completeness and accuracy. Coordinate all retrospective, concurrent, patient complaint, and external billing audits.
12. Perform audits of high risk areas and/or detailed patient records with an emphasis on the accuracy of posted charges and assigned codes by reviewing documentation, analyzing information, and researching guidelines.
13. Review Revenue Integrity workflow, charge edits, and charge issues. Report trends, identify opportunities, make recommendations, and implement changes to improve documentation, charge accuracy, and productivity.
14. Coordinate and provide education to Revenue Integrity Supervisor and Specialist and clinical department leaders when any charge opportunities are identified.
15. Inspire confidence from subordinates by performing and communicating in a highly professional, responsive, and supportive manner at all times. Promote an environment in which employees can work together towards goals and objectives.
16. Understand and stay updated of chargemaster functionality.
17. Understand the full flow of revenue cycle and Revenue Integrity’s role in it. Identify opportunities, make recommendations, and implement changes in Revenue Integrity to expedite the completion of the revenue cycle.
18. Maintain relationship and communication with other departments as they relate to charge accuracy and process improvement. Collaborate with other departments to support revenue cycle.
19. Obtain and maintain up-to-date knowledge of HCPCS/CPT coding including revenue code, HCPCS/CPT code, modifier, and charging guideline.
20. Obtain and maintain up-to-date proficiency in Epic applications related to charges and charge edits.
21. Actively participate in Revenue Cycle Improvement Teams and other teams/committees to ensure charge integrity.
22. Perform other tasks as assigned by the Director.
Follow North Oaks Health System’s compliance programs and all Federal and State Regulatory guidelines.