Revenue Integrity Supervisor

Job Summary: Under the supervision of the Manager, Coding and Compliance (MCC), the Revenue Integrity Supervisor (RIS) of Omni Family Health (Omni) provides revenue integrity support and leadership to a growing network of state-of-the-art health centers serving California's Central Valley. As a member of the organization's Fiscal Department, the RIS oversees the accuracy and compliance of charge capture, documentation, coding, and billing of clinical services across the organization. The RIS plays a critical leadership role in safeguarding organizational revenue by monitoring for discrepancies, preventing revenue leakage, and ensuring adherence to regulatory and payer requirements. With a focus on prospective review and continuous process improvement, the Supervisor works to identify issues before they impact claims, optimize charging workflows, and ensure clinical services are documented and billed correctly the first time.

Job Duties:

• Performs all duties and responsibilities of the Revenue Integrity Coordinator in accordance with organizational policies, payer requirements, and regulatory standards, including charge capture review, charge reconciliation, denial prevention, compliance monitoring, reporting, and revenue integrity improvement activities.
• Provides operational leadership and oversight of the revenue integrity program, ensuring accurate, timely, and compliant execution of departmental functions.
• Supervises Revenue Integrity staff, providing leadership, training, coaching, scheduling, performance management, and disciplinary action in accordance with organizational policies and procedures.
• Ensures appropriate staffing levels, workflow coverage, workload distribution, and prioritization of departmental activities to maintain productivity, quality, and service standards.
• Serve as the primary subject-matter expert (SME) for charge capture processes, Evaluation and Management (E/M) leveling, Federally Qualified Health Center (FQHC) Prospective Payment Systems (PPS) and State Plan Mandated (SPM) reimbursement requirements, and Revenue Cycle Management (RCM) compliance standards, providing guidance and oversight to ensure accurate charging and adherence to regulatory requirements.
• Develops, implements, and maintains revenue integrity policies, procedures, workflows, and internal controls to support compliant revenue cycle operations and accurate reimbursement.
• Oversees quality assurance activities, including routine review of documentation, charge capture, coding practices, reimbursement trends, and claim edits to ensure compliance and reduce revenue leakage.
• Ensure correct application of CPT/HCPCS, ICD-10-CM, and modifiers specific to FQHC billing.
• Ensures compliance with federal, state, payer, and program-specific regulations, including Centers for Medicare & Medicaid Services (CMS), Medicare, Medi-Cal, Health Resources and Services Administration (HRSA), Federally Qualified Health Center reimbursement requirements, and organizational policies.
• Leads internal audit activities and supports external audits, payer reviews, and regulatory assessments by ensuring documentation is accurate, complete, and readily available.
• Oversees corrective action planning and implementation efforts related to audit findings, compliance concerns, reimbursement issues, and identified process deficiencies.
• Monitors departmental metrics, reimbursement trends, denial patterns, charge lag, revenue leakage, and other key performance indicators to identify opportunities for improvement.
• Analyzes operational and financial data and provides recommendations to leadership regarding workflow improvements, reimbursement optimization, and regulatory compliance initiatives.
• Prepares and presents revenue integrity reports, findings, and recommendations to organizational leadership and other stakeholders.
• Collaborates with Revenue Cycle Management, Managed Care, Finance, Pharmacy, Information Technology, Clinical Operations, and other departments to improve revenue cycle performance and resolve operational challenges.
• Develops and facilitates training programs and educational resources related to documentation standards, charge capture practices, reimbursement requirements, and revenue integrity compliance.
• Attends management meetings and contributes to organizational planning, operational initiatives, and strategic goals.
• Ensures the department provides cohesive support to the mission, vision, and core values while delivering superior customer service.
• Works closely with all corporate branches, divisions, and/or departments in accordance with Omni's policies and procedures.
• Other duties and/or responsibilities as the (MCC) may be assigned from time to time.
• Some travel may be required.

Additional Duties:

• Health Insurance Portability and Accountability Act (HIPAA) Compliance: Responsible for maintaining abreast of and in compliance with all HIPAA regulations and requirements.
• Compliance: Ensures compliance with all local, state, and federal regulations.
• Quality Assurance/Quality Improvement (QA/QI): Participates as required in QA/QI activities and contributes towards the overall quality improvement initiatives of the organization.
• Information Technology (IT): May be required to learn and use the electronic health record and its components as required by the job functions and highlighted in the policies and procedures. These components include NextGen, Practice Management System (PMS), Quality Systems Inc. (QSI), and other electronic features as they are developed and implemented, as applicable to work environment.
• Patient Centered Medical Home (PCMH): All employees will participate in PCMH at Omni Family Health.
• Audits: Contributes to required Health Resources and Services Administration (HRSA), Operational Site Visit (OSV), The Joint Commission (JC), and other audit events.

Qualifications, Education, and Experience:

• Associate's Degree in Pharmacy, Health Information Technology, Business, Healthcare Administration, or related field.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Revenue Cycle Representative (CRCR), Certified Outpatient Coder (COC), or other related certification.
• Four (4) years of progressive experience in revenue cycle management, medical billing, coding, reimbursement, revenue integrity, or a related healthcare field, preferably within a Federally Qualified Health Center (FQHC), multi-clinc healthcare organization, or nonprofit healthcare setting.
• Knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), Evaluation and Management (E/M) documentation requirements, and related billing regulations.
• Working knowledge of 340B regulatory guidance, billing practices, pharmacy reimbursement methodologies, and Health Resources and Services Administration (HRSA) audit preparedness.
• Knowledge of Centers for Medicare & Medicaid Services (CMS), Medicare, Medi-Cal, Federally Qualified Health Center reimbursement requirements, payer guidelines, and revenue cycle compliance standards.
• Familiarity with split-billing software, reporting tools, and electronic health record (her) systems (e.g., NextGen)
• Proficient in Microsoft Office Suite (Word, Outlook, Excel).

Skills/Competencies:

• Leadership and staff development skills, with the ability to effectively supervise, coach, and develop employees while fostering accountability and continuous improvement.
• Advanced analytical and problem-solving skills, with the ability to interpret complex billing, reimbursement, and utilization data and provide actionable recommendations.
• Strong knowledge of revenue cycle operations, reimbursement methodologies, and regulatory compliance requirements.
• Ability to evaluate workflows, manage multiple priorities, and implement process improvements in a fast-paced healthcare environment.
• Collaborative and influential leadership style, with strong communication skills and the ability to work effectively across clinical, operational, financial, and revenue cycle teams.

Service Commitments:

• Must be alert and respect confidentiality of information of all types "general personnel, and/or patient related information."
• Promotes and believes in Omni's mission statement.
• Ability to relate to the public regardless of race, ethnicity, religion, age, sex, disability, or economic status.

Responsible To: Manager, Coding and Compliance

Classification: Exempt