Revenue Integrity Team Leader (Hybrid)

Are you looking for a career opportunity working for a healthcare organization that is based on excellence and love?

ChristianaCare is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. ChristianaCare includes an extensive network of outpatient services, home health care, urgent care centers, three hospitals (1,299 beds), a free-standing emergency department, a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care, and women's health. It also includes the pioneering Gene Editing Institute and was rated by IDG Computerworld as one of the nation's Best Places to Work in IT. ChristianaCare is a nonprofit teaching health system with more than 260 residents and fellows. It is continually ranked by U.S. News & World Report as the Best Hospital. With the unique CareVio data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care.

About This Position

ChristianaCare is searching for a Revenue Integrity Team Lead to be responsible for coordinating and implementing complete, correct, timely and compliant charge capture initiatives and processes. The Lead will be responsible for adhering to all government regulations and payer policies when developing charge practices in coordination with service line leaders.

PLEASE NOTE: This position is hybrid and is in-office 1-2 days per week or as needed.

Principal duties and responsibilities:

• Monitor revenue generating departments adherence to charge reconciliation processes and metrics measured by key performance indicators
• Integral to success of EMR transition from Cerner to EPIC as it relates to compliant charging
• Ensure changes within the charge description master (CDM) coincide and are implemented within clinical systems
• Lead annual, quarterly, and regular CDM maintenance activities
• Review changes in CPT, HCPCS, and revenue codes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursement
• Develop, deliver, and revise education and training programs in coordination with the revenue integrity manager
• Monitor, investigate, and resolve revenue integrity concerns reported in their area and provide any necessary follow-up
• Monitor national, state, and local information to keep current with applicable regulatory and legislative changes and implement necessary updates
• Lead weekly revenue integrity staff meetings to track progress toward work plan activities and reactive tasks
• Develop tools to track and identify potential areas of lost revenue
• Serves as a subject matter expert and in a consultative role to various levels of customers; works closely and collaboratively with Clinical Department Leaders.
• Responsibilities include all aspects of Revenue Cycle support including performance improvement, development, documentation, testing, training and upgrades. Assist management in examining processes to improve workflow.
• Reviews, monitors, and facilitates implementation of billing and coding changes affecting charge capture processes in accordance with payer requirements.
• Provides guidance and education to billing and clinical department staff related to appropriate documentation requirements, denials resolution, and regulatory requirements relevant to charging, coding and billing.
• Compiles and analyzes data from various sources to develop recommendations leading to potential revenue cycle opportunities, including analyses related to CDM set-up, charge capture, billing and/or patient financial services.
• Conducts and leads special projects to facilitate revenue management as required for new facilities/acquisitions, new departments, new service lines, changes in regulations, etc.
• Implements charge capture corrective measures and monitoring tools to ensure sustainability of changes; performs, reviews, and monitors statistics and key performance indicators to identify improvement opportunities.
• Coordinates all activities of the charge description master including but not limited to, charge creation, charge validation, charge analysis and pricing.
• Conducts root-cause analyses with others to identify opportunities for error reduction.
• Facilitates and manages the annual review and updates to the Charge Description Master and pricing file.
• Builds strong relationships and facilitates productive communication between key stakeholders and Clinical departments. Collaborates with others to develop and implement action plans to resolve charge errors.
• Researches regulatory requirements relevant to charges, monitors trends, and maintains knowledge of charge-related regulations and standards. Applies knowledge to ensure that charges are accurate, billed correctly, and supportable according to payer and regulatory requirements.

Education and experience requirements:

Bachelor’s degree from an accredited college in a relevant field of study required.

Coding Certification (CPC, COC, CCS) required. Uncertified candidates with the appropriate combination of education and experience will be allowed one (1) year from the date of hire to obtain certification.

Equivalent and relevant combination of education and experience may be considered in lieu of Bachelor’s degree.

Five years of revenue cycle management and/or revenue integrity experience in a healthcare environment required.