Manager of Revenue Integrity

Job Title: Manager of Revenue Integrity

Location: Jupiter, FL (5 days onsite per week)

Work Authorization: USC/GC Holder

Job Type: Direct-Hire

Employment Eligibility: Gravity cannot transfer nor sponsor a work visa for this position. Applicants must be eligible to work in the U.S. for any employer directly (we are not open to contract or “corp to corp” agreements).

Position Summary

Under the direct supervision of the Director of Revenue Integrity, the Manager of Revenue Integrity is responsible for managing all components of revenue integrity including leading and planning the revenue cycle operations for all aspects of facility charging. The Manager is responsible for establishing, designing, implementing, and enforcing charging and reconciliation policies and procedures, as well as streamlining and creating effective charging processes across multiple departments and service lines.

The goal of this Department is to ensure that revenue leakage is minimized. This position is highly visible and requires a strong leader with the ability to influence, prioritize, plan, multi-task, and direct the Revenue Integrity Team Members. Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact; continually reviews and monitors billing and coding changes effecting CDM and charge capture process.

Role & Responsibilities

• Reviews, develops, implements, evaluates, and revises charge guidelines to optimize revenue management; effectively implements recommendations and monitors results.
• Reviews, monitors, inputs, and facilitates implementation of billing and coding changes affecting CDM and charge capture process, in accordance with payor requirements.
• Continuously seeks ways to streamline the charge capture process by the elimination of duplicate, inactive and non-compliant charges.
• Provides guidance and education related to billing and charge capture of services to multiple staff levels; facilitates proper recording of transactions in compliance with the state, federal, and other third-party payor guidelines.
• Determines proper use of coding modifiers with regards to prebill, OCE, and LCD edits, writing physician queries, communicating with physician offices, and writing OP appeal letters.
• Reviews and analyzes Failed Claims, DNFB, Charge Error, and Charge Audit reports daily for billing edits, makes corrections as appropriate and/or assists departments to correct billing issues.
• Manages ER CPT/Facility charge capture process, ensures all ER visits are counted and charged consistently and in a timely manner, gives feedback to ER Director with regards to accurateness and completeness of nursing documentation. Composes, submits, and tracks ER physician queries.
• Plays a critical role in reducing claim underpayments and denials.
• Reviews the validity of claim adjustment reason codes (CAS), medical necessity, and charge related denials.
• Makes charge corrections when appropriate and submits for rebilling with corrected claim.
• Writes appeal letters according to CMS, ICD-10, and CPT coding and billing guidelines for outpatient medical necessity and/or charge dispute denials.
• Ensures claims were properly billed, responsible for Biller education when opportunities arise to reduce future underpayments.
• Provides support to Billing Department to resolve billing issues.
• Ability to communicate effectively with physicians, nurses, and clinical departments.
• Must be organized and ability to prioritize work.
• Understands CPT, HCPCS, ICD-10, and ICD-10 PCS coding guidelines and the use of all applicable modifiers.
• Resolves issues and problems of software systems and discusses with software analysts.
• Attends workshops, seminars and/or meetings on revenue cycle processes, updates, and accounts receivable issues as required.
• Stays current on A/R information (charges, coding, billing) and distributes new information to appropriate personnel via meetings, memos, literature, emails, and other.
• Performs appropriate revenue integrity personnel evaluations annually, or as required, and assigns responsibility to revenue integrity staff based on their skills.
• Hires, supervises, coaches, and provides corrective and or disciplinary actions to revenue integrity staff according to policies and procedures.
• Possesses a thorough working knowledge of billing requirement for various payors.
• Conducts Evaluation and Management Coding Audits to ensure the organization is meeting integrity and standards according to regulatory agencies standards and regulations.
• Conducts bi-monthly (or monthly) meetings with revenue integrity staff and appropriate personnel.
• Conducts integrity audits to ensure compliance with charging policies and procedures are followed in combination with CMS, coding, and other governing bodies’ guidelines.
• Plans and implements quality assurance for all revenue integrity processes.
• Staffing discussions and planning/interviews; team building as well as personnel development, staff meetings, educating team responsibilities.
• Assist with the implementation of changes and or updates of existing and new revenue software system; keeps relevant edits in place within the financial systems.
• Maintains applications’ access and requests for staff as needed and or required.
• Responsible for meeting expected goals and outcomes through effective, efficient, and ethical team operations and leadership.
• Prepares and or monitors operational reports for pre-billing, quality, and integrity teams as needed.
• Provides coaching and training to improve the performance of team members and recommends and or conducts corrective actions when appropriate.
• Utilizes appropriate data and statistical information to analyze trends and provide recommendations to improve the teams’ effectiveness.
• Collaborates with other departments and leadership team in other aspects of revenue cycle management such as, but not limited to, escalated claims issues, reimbursement issues and resolution, data gathering and reporting, and other, as it relates to billing, coding, and other revenue cycle management integrity reviews.

Education

• Bachelor’s Degree in Business, Finance, Accounting, and or Health Care Administration
• 5 years of Revenue Cycle Management experience; preferably in billing/coding, collections, claims, and quality and integrity audit review experience;
• OR a combination of education and 10 years comparable work experience in a coding and or billing environment.

Experience / Qualifications

• Advanced certifications preferred (e.g. CCS, CCA, RHIT, RHIA).
• Possesses CPT and ICD-10 coding experience and revenue cycle management experience.
• Knowledge of regulatory compliance, ICD-10 and CPT-4 medical record coding and UB04 billing.
• Working knowledge of a CDM.
• Understanding of payer reimbursement procedures and methodologies.
• Ability to work independently while effectively managing different priorities and projects.
• Ability to read, analyze, and interpret common and technical journals, statistical reports, and other related documents.
• Ability to effectively present information to senior management, groups, and or board of directors as directed.
• Ability to identify and define problems, collect data, establish facts, and draw valid conclusions that drives process improvement, quality, and productivity.
• Ability to analyze business situations, controls and risks, and recommend practical solutions. Have proven ability to perform strategic planning and priority setting for a revenue integrity department.
• Strong leadership skills with an ability to motivate direct reports.
• Excellent communication skills both written and verbal, and interpersonal skills. Manages and coordinates the daily activities of the revenue cycle pre-billing, quality, and integrity audit teams ensuring billing errors are corrected and the claim is submitted.
• Applications utilized include Excel, Word, PowerPoint, STAR, CERNER Power Chart and FirstNet, 3M, HPF, Experian Revenue Products, and others.