What are the responsibilities and job description for the Revenue Integrity Manager position at Premier Health Consultants LLC?
Description
Summary
The Revenue Integrity Manager improves revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation. The Revenue Integrity Manager must maintain advanced knowledge of revenue cycle processes to aid in the implementation of regulatory standards. The Revenue Integrity Manager reports to the VP of Revenue.
Essential Duties and Responsibilities
• Acts as an internal consultant analyzing and assessing diverse data relating to the revenue cycle.
• Prepares financial reports and works with revenue cycle managers to provide recommendations to the VP of Revenue
• Facilitates the dissemination of information regarding government and third-party payor regulations and requirements to clinical departments, providers, management and staff
• Oversees communication of coding and billing updates published in third-party payer newsletters / bulletins and provider manuals to all stakeholders
• Ensures adequate training and education for providers and billing staff
• Oversees charge master maintenance and development
• Oversees research of billing and coding requirements for new procedures and/or supplies.
• Ensures accurate reimbursements by investigating and educating staff members
• Communicates resolutions for identified issues with denials, billing errors, payment variances and Managed Care Contracting stakeholders. Presents regular updates on issues and efforts to Revenue Cycle leadership.
• Participates in internal and external contracted payor discussions and negotiations.
• Assists with obtaining managed care contracts for new entities. Develops and maintains a database of all payer contracts.
• Reviews and interprets managed care contracts, billing guidelines and state and federal regulations.
Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
• Technical Skills - Strives to continuously build knowledge and skills; shares expertise with others.
• Customer Service - Responds promptly to customer needs.
• Interpersonal Skills - Maintains confidentiality.
• Oral Communication - Responds well to questions; participates in meetings.
• Written Communication - Presents numerical data effectively.
• Teamwork - Balances team and individual responsibilities; contributes to building a positive team spirit.
• Quality Management - Demonstrates accuracy and thoroughness.
• Business Acumen - Understands business implications of decisions; displays orientation to profitability.
• Cost Consciousness - Works within approved budget; develops and implements cost saving measures; contributes to profits and revenue; conserves organizational resources.
• Diversity - Promotes a harassment-free environment.
• Ethics - Keeps commitments; works with integrity and ethically; upholds organizational values.
• Organizational Support - Follows policies and procedures.
• Judgment - Exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process; makes timely decisions.
• Motivation - Sets and achieves challenging goals; demonstrates persistence and overcomes obstacles.
• Planning/Organizing - Prioritizes and plans work activities; uses time efficiently; organizes or schedules other people and their tasks.
• Professionalism - Reacts well under pressure; accepts responsibility for own actions; follows through on commitments.
• Quality - Monitors own work to ensure quality.
• Adaptability - Changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events.
• Dependability - Keeps commitments; commits to long hours of work when necessary to reach goals.
Education and/or Experience High school graduate or equivalent. 3 years of supervisory experience preferred. 5 years of Medical Accounts Receivable experience preferred.
Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Reasoning Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Computer Skills To perform this job successfully, an individual should have advanced knowledge of Microsoft Office products - Outlook, Access and Excel
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to handle or feel; reach with hands and arms and talk or hear. The employee may be required to occasionally lift, push, or pull up to 50 pounds.
Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually quiet to moderate. The employee may be exposed to infectious or contagious diseases and a variety of electromechanical hazards. The employee may also handle emergency and/or crisis situations.
The above job description is intended to describe the general nature and level of work being performed in the described position. This document is not intended to be an exhaustive list of of all position duties and skills required of the individual classified in this position.
