What are the responsibilities and job description for the Revenue Integrity and Contract Manager position at Community of Hope?

Job Type

Full-time

Description

Revenue Integrity and Contract Manager

Are you excited about a new opportunity? Do you have a passion for delivering high quality service? Are you mission-driven to help towards improving health and eliminate inequities in health outcomes in under-resourced communities in DC? Well, look no further! At Community of Hope, we have worked diligently to improve health and end family homelessness to make Washington, DC, more equitable. We believe everyone in DC should have access to good healthcare, a stable income, and home, and hope! If you are ready to make a positive difference in the community, this position is for you!

At COH, we strive for : Caring for Families. Improving Lives. Leading Change

Our Approach and Values :

We care for families by providing direct services with a focus on prevention, healing, and wellness.

We improve lives by building on families' strengths, honoring their choices, and taking a whole-family, multi-generational approach.

We lead and advocate for system change to address the effects of historical and current racial inequities on health outcomes and housing opportunities.

We embrace the diversity of our community , welcome all voices and perspectives, and treat everyone with respect, compassion, and integrity.

We strive for excellence in all that we do, implement evidence-based practices, measure our outcomes, and use this knowledge to continuously strengthen our work.

Position Summary :

The Revenue Integrity and Contract Manager coordinates and leads performance of analysis, maintain fee schedule, create reports used to inform financial strategies and operations, develops and validates operational information for clinical and billing accuracy. The Revenue Integrity and Contract Manager contributes to the development and implementation of data integrity and initiatives that focused on quality improvement and operational efficiency; optimize reimbursement for services rendered.

The pay rate for this position ranges between $70,000 - $80,000 annually and the offer amount is determined by the candidate's education, qualifications, and experience . Indeed provides their own estimated salary calculator and is not affiliated with COH's range.

Highlighted Duties and Responsibilities :

Revenue Integrity Manager Responsibilities :

Collaborates with Health Operation nurse to identify and update charges and medications for any obsolete or inactive items on fee schedule twice a year.
Monitors and maintains the Charge Description Master (CDM) for all service lines and provides the appropriate information for correct codes.
Keep current on coding and chargemaster related issues through monitoring of the regulatory environment, review DC Medicaid, participation in professional organizations and continuing education.
Prepares written documentation and reports of various types; application documentation, analytical reports, functional specifications, training manuals, status reports, etc. monthly and quarterly.
Works with all department / service line leadership and serve as the subject matter expert regarding accuracy of charge capture processes and risk.
Audits payer performance monthly for revenue integrity.
Manages fully executed contracts and fee schedules / rates to ensure the contracts are created and loaded in accordance with state, government, and payor policies within Billing system.
Work closely with Health Operations Departments, Billing Manager and Data Analytic Coordinator to resolve charge capture related issues.
Ensure that eClinicalWorks system remains updated to allow for accurate coding and charge capture.
Maintains a required comprehensive understanding of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) guidelines and Medicaid / Medicare regulatory guidelines, as well as the understanding of eClinicalWorks system build and its related charge capture processes.
Creates workflows and processes to ensure accurate and timely cost / charge capture and billing compliance; Prepares and submits audit findings and makes recommendations to Director of Billing.
Completes other duties as assigned by the Supervisor.

Contract and Billing Responsibilities :

Manages the Patient Billing Data Analytic Coordinator and Credentialing Team Lead.

Audits the productivity for assigned team members weekly to ensure accuracy. To include quarterly risk compliance report, and all areas of credentialing and patient statements.

Reviews the Billing Manual Standard Operating Procedures quarterly for any updates and revision that needs to occur.

Responds to staff, management, payers and vendors within 1-2 business days.

Analyzes and negotiates payer contracts to achieve the best agreement for the organization.

Creates monthly A / R modeling report and annual UDS report.

Monitors and creates financial targets, trends and develop action plans working with members of applicable teams to correct or improve any variances; serving as a resource for answering revenue integrity, charge review / edit and module information to ensure maximum reimbursement and compliance.

Supervisory and Leadership Responsibilities :

Meets with supervisees regularly and provides real-time feedback, training, support, and coaching as needed. Creates meeting agendas, sends meeting agendas in advance when possible, and documents concerns promptly as needed.

Applies principles learned through diversity, equity, and inclusion (DEI) trainings and / or trauma informed care trainings (TIC) and leads with a DEI and TIC lens when appropriate.

Reviews the performance of team members in a timely manner, including completing 90 day and annual performance evaluations per their due dates, documenting any issues or changes, providing recommendations for professional development and / or training opportunities, and recognizing staff when appropriate.

If applicable, actively recruits for vacancies with a sense of urgency. This includes reviewing resumes, phone screening, interviewing, and completing references. This also includes partnering with Talent Management for assistance to fill vacancies promptly.

Delegates tasks appropriately to team members to ensure that team goals and responsibilities are achieved. Prioritizes tasks and directs work to ensure deadlines are met.

Establishes common goals with their team through communication, inspiring and leading team members, and holding team members accountable. Links team goals and metrics to the overall strategic plan.

When appropriate, creates opportunities for teambuilding that connects staff to one another and COH's mission to encourage connection between staff who are virtual, hybrid, and / or on-site.

Handles sensitive information with care and discretion to ensure confidentiality.

Requirements

Minimum Qualifications :

High School Diploma required, but strongly prefer bachelor's or Associates degree.

Five years of supervisor experience required in healthcare, but 8 strongly preferred in healthcare.

Required advanced analytical capabilities in Microsoft Excel (pivot tables, VLOOKUP's, macros, visual basic) and intermediate capabilities in Microsoft Access, PowerPoint, and Visio.

Certified Professional Coder through AAPC a plus.

Financial modeling and ability to navigate complex formulas.

Exceptional follow-up skills, high-level of accuracy and initiative.

Strong analytical and problem-solving skills.

Working knowledge of payer contracts, contract language and negotiation strategies.

At COH, we understand the toll that the Covid-19 pandemic has taken on the workforce, which is why we prioritize the following well-being and work-life balance centered benefits :

Remote work opportunities are available for many of our roles, promoting a culture of work-life balance

8-hour workdays, which include a paid lunch

11.5 paid company holidays, 1 personal floating holiday, 15 days of paid vacation (increases to 20 after 3 years of service), and 12 days of paid sick leave on an annual basis

Annual performance-based raises, up to 5% of your annual pay

Tuition reimbursement, loan repayment for clinicians, licensing reimbursement, and continuing education unit funds for licensed staff

Many opportunities for internal promotions and transfers across the agency as we continue to grow; we average 30 promotions each year

Ongoing internal leadership training for supervisors

Diversity, equity, and inclusion training and initiatives for all staff

Ongoing wellbeing activities, culture compact activities, and trauma-informed care initiatives

Medical / Dental / Vision Plans through CareFirst BlueCross Blue Shield

Life insurance, short-term disability and long-term disability insurance

403(b) Retirement Plan

Flexible Spending Accounts for medical and dependent care reimbursable expenses

And much more!

In relation to remote work versus on-site expectations, this position is classified as the following :

Remote : A majority of the position may be able to work remotely, but employees will be required to report to the office a minimum of twice per month.

Please note that remote work designations are subject to change or fluctuate at any point in time and the supervisor may require in person learning for a specific amount of time after hire.

About Us :

Community of Hope is a mission-driven, innovative, and rapidly growing nonprofit. For over 40 years, we have provided healthcare, housing, and supportive services for under-resourced, underserved and people experiencing homelessness in Washington, DC. As a Federally Qualified Health Center, we provide medical, dental, emotional wellness, and care coordination services for the whole family at three locations in DC. Community of Hope also strongly emphasizes maternal and child health, with midwifery practice and the only free-standing birth center in DC. In 2020, Community of Hope provided about 28,400 medical visits, 7,000 dental visits, and 10,000 behavioral health visits for about 11,000 patients. Community of Hope provides community walk-in COVID testing and COVID vaccines. Community of Hope is also one of the largest providers in DC of housing and support services for families and individuals experiencing homelessness. Through providing these programs, we live out our mission to improve health and end family and individual homelessness to make Washington, DC, more equitable.

Community of Hope cares for families and individuals by providing direct services focusing on prevention, healing, and wellness. We improve lives by building on families' and individuals' strengths, honoring their choices, and taking a whole-family, multi-generational approach. We lead and advocate for system change to address the effects of historical and current racial inequities on health outcomes and housing opportunities. We embrace the diversity of our community, welcome all voices and perspectives, and treat everyone with respect, compassion, and integrity. We strive for excellence in everything we do, implement evidence-based practices, measure our outcomes, and use this knowledge to strengthen our work continuously. We were selected as one of The Washington Post 150 Top Workplaces in 2014, 2016, 2017, 2018, 2020, and 2021 based on feedback from our staff.

To request a reasonable accommodation to complete an employment application or for general questions about employment with Community of Hope, contact a Recruiting Coordinator. Email : hr@cohdc.org Phone : 202-407-7747. Community of Hope is an equal opportunity employer.

Salary Description

70,000 - $80,000 annually

Salary : $70,000 - $80,000

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