Manager Revenue Integrity

Overview

The Manager of Revenue Integrity is responsible for the leadership, development, coordination, implementation, and oversight of one or more Revenue Integrity team functions. These functions aim to support the organization with revenue and charging related questions as well as proper research and set up of charge processes and pricing to ensure accurate, timely charging. This role works cross functionally across the continuum of Revenue Cycle and maintains knowledge of charging workflows within the EHR, including its various application and software's. The manager of Revenue Integrity completes metrics reporting as required and collaborates with IT in maintaining system applications. This role partners cross functionally with clinical and revenue cycle operational departments to achieve optimal system performance.

Responsibilities Job Description

Directs Operations

• Sets, oversees, and ensures daily operations, service support and outcomes are performed timely and accurately in accordance with regulatory and payer requirements.
• Ensures work assignments are performed and supported to achieve departmental goals and outcomes
• Ensures continuous improvement in people, process and technology related to charging creating maximum efficiency
• Track and assess integrity risks, and ensure the revenue integrity program is responsive to those risks, activates additional financial controls as appropriate and follow through to resolution
• Lead the enhancement of charge description master (CDM) activities and support maintenance of integrated revenue cycle applications, reviewing and optimizing organizational CDM structures to ensure all services and supplies are reflected accurately and are consistent with current industry best practices. Include clearly stated service level agreements and accountability for updates by all stakeholders
• Lead and/or actively participate in committees addressing and/or responsible for revenue integrity activities
• Sets metrics and works to achieve industry level benchmarks for department and team.
• Selects, hires, orients, and trains qualified employees to perform job responsibilities, mentor and evaluate staff
• Provide routine performance reports regarding the nature, progress and status of the revenue integrity program, any course correction being taken, and any recommended changes
• Ensure staff members are knowledgeable about revenue assurance needs and reimbursement issues identified through audits, reviews, and aggregate data analysis.
• Designs and helps maintain workflows to ensure efficient and effective processes
• Develops and implements key productivity and quality standards for department processes
• Monitors and prioritizes work based on organizational needs and assignments, appropriately assure timely, productive, and efficient use of resources
• Provides technical expertise, troubleshooting issues, and input on improvement projects and product selection
• Identifies, evaluates, coordinates and implements tactics to achieve organizational objectives, improve operational efficiencies, and increase positive cash flow
• Fosters a culture of improvement, efficiency and innovative thinking
• Maintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures and standards.
• Provides oversight to assure compliance with established laws, regulations, practices, and procedures.
• Responsible for providing the operational oversight for system wide charge capture activities.
• Provides operation direction for Charge Capture Integrity, aligning direction with customer expectations, financial expectations, environmental requirements, and organizational objectives. This includes:
  • The analysis of department charges,
  • The identification and implementation of charge improvement strategies
  • Assisting departments with their charge capture activities including the development of charge reconciliation processes where needed.
• Develop and implement a formalized system-wide charge capture education plan including execution strategy and routine updates as needed
• Monitoring, evaluation, and management of Department Budget by RCM leadership to achieve budget
• Revenue Cycle Budgets - create Yearly Budget; Maintain and review monthly Budget
• Performs the duties as assigned

Develops Strong Work Relationships

• Leads or participates in in work with peers and other departments to create an excellent understanding of workflows and interdependencies, and to identify and implement strategies to improve revenue cycle performance
• Works collaboratively with vendors to assure performance expectations are being met
• Represent Revenue Cycle and Fairview Health Services at industry forums to network and identify process improvement opportunities
• Serves as a resource on revenue cycle issues and regulatory expectations
• Creates strong collaborative partnerships and influence others across teams, groups and business boundaries to achieve real world problem solving

Skills, Abilities and Organization Expectations:

• Thorough knowledge of functions assigned
• Thorough knowledge of computer systems used by assigned revenue cycle team
• Knowledge of applicable regulatory requirements
• Knowledge and understanding of hospital revenue cycle operations (registration, charge capture, health information management, claims, payment posting)
• Ability to present to small and large groups
• Consistent demonstration of excellent written and verbal communication skills
• Proficiency in Microsoft Office: Word, Excel, Power-Point, Visio, Teams, SharePoint and Outlook.
• Performance improvement, project management and/or lean skills

Organization Expectations, as applicable:

• Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served.

• Partners with patient care giver in care/decision making.
• Communicates in a respective manner.
• Ensures a safe, secure environment.
• Individualizes plan of care to meet patient needs.
• Modifies clinical interventions based on population served.
• Provides patient education based on as assessment of learning needs of patient/care giver.

• Fulfills all organizational requirements.
  • Completes all required learning relevant to the role.
  • Complies with and maintains knowledge of all relevant laws, regulations, policies, procedures and standards.
• Fosters a culture of improvement, efficiency and innovative thinking.
• Performs other duties as assigned.

Qualifications

Required Qualifications

Education

• Bachelor's degree in business administration, Health Care Administration or related area PLUS 2 years of experience in health care reimbursement, financial management or coding OR an approved equivalent combination of education and experience

Experience

• 3 years of applicable leadership business-related experience

License/Certification/Registration

• One or more of the following: RHIA, RHIT, CHRI, CCS, , CPC, CCS-P, RN,

OR

• Epic Resolute Certification(s) in one or more of the following Epic applications: Resolute Professional Billing, Resolute Hospital Billing, Claims, completed within 1 year of employment.

Preferred Qualifications

Education

• Bachelor's Degree in Business Administration, Health Care Administration, Nursing, Education or related area

Experience

5 years' experience in coding, clinical documentation improvement (CDI) professional revenue integrity, quality, or a directly related functional area of work

License/Certification/Registration

• One or more of the following: RHIA, RHIT, CHRI, CCS, CPC, CCS-P, RN,

AND

• Epic Resolute Certification(s) in one or more of the following Epic applications: Resolute Professional Billing, Resolute Hospital Billing, Claims

EEO Statement

EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status