The Revenue Integrity Manager will facilitate improvement in the overall quality, completeness and accuracy of the Revenue process. Reporting directly to the Revenue Cycle Director, this individual will work independently and be responsible for reviewing and analyzing information to identify trending and root-cause for billing and reporting issues. Develop and implement action plans for addressing and resolving all billing/charging issues. Will facilitate staffing and reporting changes to improve net revenue and reduction in denials. Provide support, education and guidance to Clinical and Administrative departments to maximize appropriate revenue for the Healthcare System.
PRINCIPAL JOB FUNCTIONS:
*Commits to the mission, vision, beliefs and consistently demonstrates our core values.
*Responsible for Reporting in the Revenue Integrity Area
Establish and monitor revenue related Key Performance Indicators (KPI), metric goals, and reporting for the Revenue Integrity functions for the organization
Establish and monitor leadership approved aggregate revenue reporting and department level reporting across the organization, inclusive of baseline data/trends
Establish and maintain department level revenue reconciliation reports and tools
Monitor department owned charge review work queue volumes
*Revenue Integrity Workshops
Establish Revenue Integrity Workshops, roles & responsibilities, mission, purpose, and charter in preparation for the Epic Go-Live and for new revenue producing managers within the organization
Serve as a lead with department heads and other hospital personal and executives for the purpose of information gathering to enhance revenue integrity opportunities
Lead regular post-live Revenue Integrity Workgroup meetings with department leads, establishing a culture of accountably at the department level
Openly communicate issues and opportunities to appropriate
*Department Revenue Reconciliation
Work to ensure departments have the tools and reports needed to reconcile their revenue as well as identify training and educational opportunities
Assist in the development of standardized tools, resources and policies and procedures
*Management of the Revenue Integrity Team
Analyzes revenue impact associated with various projects to determine priority and value
Supervises the activities of the Revenue Integrity team, and ensures quality output on assignments
Provides regular status updates to Revenue Cycle leadership, and communicates relevant concerns and issues to the department as a whole as needed
Develop individual action plans for Revenue Integrity Associates improvement
Conduct interim and annual reviews for Revenue Integrity Associates
Manage Revenue Integrity resources and track department risks and mitigation progress
Maintain up-to-date knowledge of regulatory changes impacting charging practices
Act as a resource to Revenue Integrity Associates for complex questions, complicated cases, and compliance information
Will manage and assure a compliant chargemaster.
Work with Department Directors on developing new charges and pricing.
Revise and update the chargemaster when need arises
Responsible to assure that billing is audited yearly to review compliance
Work with Legal to develop yearly audit plan and help implement
In conjunction with the Senior Director of the Revenue Cycle, Lead the bi-monthly denials committee
Assure the denials committee is working towards avoidance on all avoidable denials throughout the Medical Center
Manage the Denials team to assure that denials inventory is being worked and write-offs comply with the current policy and procedure.
EDUCATION AND EXPERIENCE:
Undergraduate degree in Business or related field. Minimum five years health care with at least three years of Healthcare Finance or Accounts Receivable Management experience. Experience as Revenue Integrity Manager preferred
Proficient knowledge of chargemaster components (CPT codes, HCPCs, Revenue Codes, G/L and Cost centers)
Thorough knowledge of inpatient, outpatient and clinical billing requirements
Expert knowledge of coding guidelines and CMS reimbursement methodologies
Experience with Epic Resolute Hospital Billing
Functional knowledge of HIPAA rules and regulations and experience related to privacy laws, access and release of information
Knowledge of Inpatient Prospective Payment System (IPPS), Coding Regulations and documentation requirements.
We're a Nebraska governed, nonprofit health system that cares for patients, educates tomorrow's health care providers and motivates our community with fitness and health programs. Our award-winning network of doctors, hospitals and medical providers offers effective care; works with industry leaders to introduce leading-edge, proven treatments to our region; and serves rural communities through o...utreach clinics, mobile services and telemedicine care. We're always focused on providing the personalized care and programs that make a difference in your life.