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- Pasadena, CA
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Manager, Revenue Integrity
The Judge Group • Pasadena, CA
Posted 27 days ago
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This position is located in Pasadena, CA!
Key attributes for an individual to be successful in this position:
- Maintains the charge master in accordance with the organization’s Charge Description Master Policy by incorporating new charges/services identified by departments, third-party changes, special requirements, coding updates and applicable laws and regulatory requirements.
- Maintains an audit trail of charge master changes, communicates these changes to administration and the hospital departments that will be impacted.
- Performs a detailed annual review of the charge master, which includes identifying codes that have been deleted, added, or replaced; identifying description changes, including assigning and validating appropriate revenue codes specific to payer requirements.
- Coordinates meetings with departments regarding new program and procedure developments, equipment acquisitions, validation of inactive codes and development of charge codes.
- Supports and advises clinical areas throughout the hospital system in charge capture, coding accuracy and revenue management.
- Conducts reviews of departments and services performed to identify and optimize reimbursement for the system while ensuring compliance with applicable laws and regulations, including assigning and validating appropriate revenue codes.
- Supports clinical areas and departments in charge capture, coding accuracy, and revenue management in order to ensure organization-wide uniformity of charges and coding for similar products and procedures.
- Identifies/investigates issues with medical necessity, coding and billing that reduce reimbursement; recommends action steps and works collaboratively with the department to improve processes when operational weaknesses and/or compliance issues are found.
- Ascertains compliance and established policies, plans and procedures as well as external regulations.
- Interfaces with physicians, managers, and staff in departments to ensure quality work product and assists in special revenue management projects.
- Completes and provides management reports as requested.
- Maintains and chairs the organization’s Revenue Cycle Team Committee according to the Charge Description Master Policy.
- Bachelor's degree or equivalent in Finance, Accounting, Health Care Administration, Public Health Administration, Health Information Management, Business Administration, Information Systems, or other related field.
- Master's degree strongly preferred.
- Minimum of 8 to 10 years of progressive experience within a healthcare environment, including supervision and project management.
- Strong background in Healthcare Finance, Compliance, Information Management, or Audit required.
- Extensive knowledge and demonstrated expertise within healthcare delivery systems, with particular emphasis on revenue cycle activities, including billing requirements and payment methodologies for physician and/or hospital medical services.
- Understanding of physician (CMS 1500) and hospital (UB04) billing and coding practices (CPT4, ICD9/10, APCs, and DRGs, etc.).
- Working knowledge of government regulations pertaining to HMOs, providers, and to Medicare/Medicaid.
- Proven ability to effectively communicate both verbally and in writing with parties who may have different and/or conflicting interests and interpretations.
- Superior skills in conflict resolution and meeting facilitation and project management.
Please send your MOST UP TO DATE resume to Jaclyn at [Click Here to Email Your Resumé] or call Jaclyn at 949-383-2542.
Thank you so much!