Systems Manager of Revenue Integrity Full Time 40 hours

Description

Under the direction of the Systems Revenue Cycle Director, the Systems Revenue Integrity Manager defines and carries out the strategy for maximizing gross and net revenue capture across the Bristol Health enterprise. The Manager serves as the chief liaison between revenue cycle and clinical departments. The Manager also ensures the availability and interpretation of reporting and analytics necessary for the clinical and revenue cycle departments to drive financial improvement. 

Within the Revenue Integrity department, the Manager oversees the following functions: charge capture, revenue reconciliation, Charge Description Master (CDM) maintenance, strategic pricing, payment validation, denial management and avoidable write-off prevention, and reporting and analytics.

Essential Job Functions and Responsibilities:

• Lead the Revenue Integrity Department in the efficient and compliant manner of the Revenue Cycle.

• Oversee monitoring and improvement efforts within the functional areas of Revenue Integrity, including:  

  • Charge Capture – Ensure appropriate audit activities take place prior to and after billing to ensure accurate and optimal revenue capture and seek to continually improve charging processes within departments. 

  • Revenue Reconciliation – Provide oversight of Revenue Reconciliation completed by operational and clinical leads across Bristol, including the use of appropriate tools to support revenue and charging reconciliation.

  • CDM Management – Ensure the Charge Description Master is maintained, new codes are entered timely, and any pre-bill edits are worked timely. 

  • Strategic Pricing – Provide oversight for annual price increases across the organization. Understand pricing goals and net impact of associated price increases. 

  • Payment Validation – Ensure accurate reimbursement by payors through internal processes and tertiary processes.

  • Denial Management & Avoidable Write-Off Prevention – Utilize data analytics to identify trends and work with functional areas for future prevention.

  • Reporting & Analytics – Provide objective analysis through advanced reporting and interpretation of findings to support Revenue Integrity processes.

• Oversee all functions performed by the Revenue Integrity team, including analytics and reporting, communication with departments and external stakeholders, and ongoing strategy and development of the program. 

• Work with team to develop meaningful metrics and key performance indicators departments to drive strategic analysis and decision-making.

• Lead targeted revenue improvement opportunities and assist with analyzing the financial impact as related to professional and hospital clinical departments.

• Work proactively with leadership within Revenue Cycle and Finance to prioritize areas of focus and ensure appropriate ongoing performance.

• Assist in the development and maintenance of appropriate controls and security of processes that lead to accurate clinical, operational, and financial operations.

Qualifications

Educational / Minimum Requirements:

• Master’s degree in Health Care Administration, Business Administration or equivalent preferred 

• Eight years hospital revenue cycle or reimbursement experience, including seven (7) years Management experience, with emphasis on project management.

State/Federal Mandated Licensure or Certification Requirements:

None

Bristol Hospital Mandated Educational Requirements:

General orientation at time of hire. Fire/Safety/Infection Control annually. 

Special Requirements:

Ability to effectively manage multiple tasks and projects. Strong computer analytical skills with an aptitude for learning new software programs and the ability to assimilate changes. Outstanding supervisory and interpersonal skills.

Physical Requirements:

Prolonged sitting at a desk and/or computer terminal. Significant paperwork requiring extensive eye usage. Physically able to handle paperwork and patient filing. Vision and hearing corrected to normal. 

Work Environment:

Normal office conditions.

Cognitive Requirements:

Strong interpersonal skills; ability to deal effectively with physicians, clients, and other related professional personnel. Excellent mathematical and analytical skills; must be able to reconcile patient accounts and spreadsheets expediently. Detail oriented personality. Excellent written and oral communication skills. Ability to work independently with minimal direct supervision.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.