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  • Pasadena, CA

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Manager, Revenue Integrity

The Judge Group • Pasadena, CA

Posted 27 days ago

Job Snapshot

Degree - 4 Year Degree
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Job Description

Judge Healthcare is actively seeking a full time Revenue Integrity Manager for the nation's premier health systems!!

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.
Minimum Education 
  • 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 Work Experience and Qualifications 
  • 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!


Job ID: 543662
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