Manager, Revenue Integrity

Schedule: Monday - Friday 8:00a - 5:00p, on site

Position Summary

The Revenue Integrity Manager is responsible for oversight of all aspects of the revenue cycle, including billing, collections, utilization review, coding, compliance, financial counseling, comprehensive analysis and leadership. The Revenue Integrity Manager will lead the revenue cycle initiatives. The Manager will also play a key role in the optimization and operational use of the newly implemented electronic health record (Cerner). The Manager will also lead other projects as required.

Key Functions

• Manage all aspects of revenue integrity from charge capture to final bill collection. Leads the revenue integrity team in an efficient and compliant manner.

• Charge Capture and Revenue Integrity

• Oversees and manages the Charge Master and pricing

• Develops and oversees processes to ensure charge capture, coding, chart audits and charge corrections. Oversees provider education related to coding and documentation.

• Accounts Receivable

• Responsible for day to day revenue cycle operations, including but not limited to:

• Monitoring accounts receivable balances

• Aging activity

• Collections

• Billing and Coding

• Utilization review and appeals

• Contractual adjustments

• Denial management

• Customer service

• Monitors accounts receivable activity to ensure aging is within company targets.

• Ensure demographic information is accurate and complete.

• Responsible for developing and adhering to revenue cycle policies and procedures.

• Insurance/Private and Third-Party Payors

• Participate in strategic projects including:

• Contract management with insurance companies

• Contract management with corporate clients

• Provide oversight of insurance related activities, including:

• Insurance verification and authorization

• Monitor and interpret insurance reimbursements

• Insurance company inquiries

• Claim tracking and denial management

• Patient inquiries

• Business Development/Process Improvement

• Lead the business development activities in support of an evolving revenue cycle department

• Participate in PDSA cycles and project management related to revenue cycle improvements.

• Implement procedures that ensure optimum reimbursement and compliance with regulations.

• Reporting and Analysis

• Develop and manage department key performance indicators (KPI)

• Produce management reports in support of revenue integrity

• Provide analysis through advanced reporting and interpretation of findings in support of revenue enhancement and process efficiency

• Participate in AHA survey, as needed

• Participate in financial statement annual audit

• Leadership

• Hire, manage, train, and evaluate professional level staff.

• Develop, implement, and monitor practices that are in compliance with company policies and procedures.

• Other duties as assigned

Education Required: Bachelor's degree in healthcare administration, clinical discipline or equivalent.

License/Certification: Certification from AHIMA, AAPC preferred.

Experience Required: 7 years' experience in health care revenue cycle activities, including at least 2 years in hospital revenue cycle supervision or management; proficient in billing, coding, and collections; must have strong micro-computer skills; ability to multi-task and ability to provide excellent customer service. Knowledge of hospital billing cycle processes.