Manager Revenue Integrity
Apply NowCompany: Children's Health
Location: Dallas, TX 75217
Description:
Job Title & Specialty Area: Manager Revenue Integrity
Department: Revenue Integrity
Location: Children's Health- Dallas
Shift: Full-time Monday through Friday 8:00 am to 5:00 pm
Job Type: Remote with some on-site attendance required
Why Children's Health?
At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.
Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being.
Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.
Summary:
Oversees professional staff responsible for providing charge capture and chargemaster expertise to all revenue generating service lines. Additionally, oversee charge capture edit resolution to ensure accurate claims submission. Ensures charge capture processes and system builds adheres to all payor regulatory directives and guidelines.
Responsibilities:
* Oversees maintenance of accurate and timely patient accounting system(s) changes/updates to sustain data integrity and to facilitate claims processing; ensures quality reviews occur to identify and minimize system errors.
* Plans revenue management strategies as identified in data/report analyses to ensure consistency/standardization, to identify improvement opportunities, and to facilitate appropriate knowledge transfer.
* Define problems, collect data, establish facts, draw valid conclusions, and make recommendations for improvement
* Read, review, analyze, and interpret a variety of state/federal regulatory information and managed care contracts and the affect on appropriate claims production, clinical/order entry systems, ancillary systems, and CDM
* Utilize and research various published resources, appropriate reference materials, Internet resources, seminars, and other associated information sources to continually stay abreast of changes in regulatory information
* Serves as a resource to all service lines as well as revenue cycle works closely and collaboratively with all departments
* Manages a professional team to evaluate, review, plan, implement, and report various revenue management strategies to ensure Charge Capture and CDM integrity; to identify improvement opportunities; and to facilitate appropriate education
* Evaluates and maintains workflow processes to ensure efficiencies; works with all personnel involved in the revenue cycle to optimize CDM interfaces and processes
* Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact and to ensure optimal revenue management; continually reviews and monitors billing and coding changes affecting CDM and charge capture processes to ensure accurate claims production, appropriate distribution of information, and to identify target areas for education
* Provides incident management and problem resolution; views incidents and problems from a systemic perspective to determine system-wide solutions; oversees implementation of recommendations and monitors results to prevent recurrence; investigates complex issues as required
* Manages implementation of CDM and/or charge capture corrective measures and monitoring tools to ensure sustainability of changes; reviews and monitors statistics and key performance indicators to identify improvement opportunities and ensure compliance with regulatory/non-regulatory directives
* Oversees pricing initiatives such as strategic pricing, across-the-board increases, tiered pricing, pricing transparency; conducts interim pricing reviews and performs financial analyses for strategic initiatives
* Manages daily WQ processes related to charge capture and charge claim edit to ensure effective resolution and timely claim processing.
* Works with revenue cycle areas to evaluate impacts on AR reduction of billed service by assisting with issues related to billing and denials related to charging
* Manages/oversees special projects and special studies as required for new clients, system conversions, acquisitions, new departments, new service lines, changes in regulations, legal reviews, etc.
How You'll Be Successful:
Work Experience
* At least 5 years' experience in revenue cycle processes, medical billing and coding processes, basic accounting principles, quantitative decision making and process analysis Required
* At least 3 years' Experience working and completing charge master/charge capture and revenue analytics around charge capture activities Preferred
* At least 2 years of progressive experience in management within a hospital department Preferred
* Problem solving/analytical skills to assess operational needs and facilitates the implementation of processes, protocols and tools to meet the identified need Required
Education
* Four-year Bachelor's degree or equivalent experience Required
* Graduate or professional work or advanced degree; or equivalent experience Preferred
Licenses and Certifications
* Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, CPC-H, CCS, RHIA, RHIT Preferred
A Place Where You Belong
We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.
Holistic Benefits - How We'll Care for You:
Employee portion of medical plan premiums are covered after 3 years.
4%-10% employee savings plan match based on tenure
Paid Parental Leave (up to 12 weeks)
Caregiver Leave
Adoption and surrogacy reimbursement
As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.
Department: Revenue Integrity
Location: Children's Health- Dallas
Shift: Full-time Monday through Friday 8:00 am to 5:00 pm
Job Type: Remote with some on-site attendance required
Why Children's Health?
At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.
Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being.
Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.
Summary:
Oversees professional staff responsible for providing charge capture and chargemaster expertise to all revenue generating service lines. Additionally, oversee charge capture edit resolution to ensure accurate claims submission. Ensures charge capture processes and system builds adheres to all payor regulatory directives and guidelines.
Responsibilities:
* Oversees maintenance of accurate and timely patient accounting system(s) changes/updates to sustain data integrity and to facilitate claims processing; ensures quality reviews occur to identify and minimize system errors.
* Plans revenue management strategies as identified in data/report analyses to ensure consistency/standardization, to identify improvement opportunities, and to facilitate appropriate knowledge transfer.
* Define problems, collect data, establish facts, draw valid conclusions, and make recommendations for improvement
* Read, review, analyze, and interpret a variety of state/federal regulatory information and managed care contracts and the affect on appropriate claims production, clinical/order entry systems, ancillary systems, and CDM
* Utilize and research various published resources, appropriate reference materials, Internet resources, seminars, and other associated information sources to continually stay abreast of changes in regulatory information
* Serves as a resource to all service lines as well as revenue cycle works closely and collaboratively with all departments
* Manages a professional team to evaluate, review, plan, implement, and report various revenue management strategies to ensure Charge Capture and CDM integrity; to identify improvement opportunities; and to facilitate appropriate education
* Evaluates and maintains workflow processes to ensure efficiencies; works with all personnel involved in the revenue cycle to optimize CDM interfaces and processes
* Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact and to ensure optimal revenue management; continually reviews and monitors billing and coding changes affecting CDM and charge capture processes to ensure accurate claims production, appropriate distribution of information, and to identify target areas for education
* Provides incident management and problem resolution; views incidents and problems from a systemic perspective to determine system-wide solutions; oversees implementation of recommendations and monitors results to prevent recurrence; investigates complex issues as required
* Manages implementation of CDM and/or charge capture corrective measures and monitoring tools to ensure sustainability of changes; reviews and monitors statistics and key performance indicators to identify improvement opportunities and ensure compliance with regulatory/non-regulatory directives
* Oversees pricing initiatives such as strategic pricing, across-the-board increases, tiered pricing, pricing transparency; conducts interim pricing reviews and performs financial analyses for strategic initiatives
* Manages daily WQ processes related to charge capture and charge claim edit to ensure effective resolution and timely claim processing.
* Works with revenue cycle areas to evaluate impacts on AR reduction of billed service by assisting with issues related to billing and denials related to charging
* Manages/oversees special projects and special studies as required for new clients, system conversions, acquisitions, new departments, new service lines, changes in regulations, legal reviews, etc.
How You'll Be Successful:
Work Experience
* At least 5 years' experience in revenue cycle processes, medical billing and coding processes, basic accounting principles, quantitative decision making and process analysis Required
* At least 3 years' Experience working and completing charge master/charge capture and revenue analytics around charge capture activities Preferred
* At least 2 years of progressive experience in management within a hospital department Preferred
* Problem solving/analytical skills to assess operational needs and facilitates the implementation of processes, protocols and tools to meet the identified need Required
Education
* Four-year Bachelor's degree or equivalent experience Required
* Graduate or professional work or advanced degree; or equivalent experience Preferred
Licenses and Certifications
* Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, CPC-H, CCS, RHIA, RHIT Preferred
A Place Where You Belong
We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.
Holistic Benefits - How We'll Care for You:
Employee portion of medical plan premiums are covered after 3 years.
4%-10% employee savings plan match based on tenure
Paid Parental Leave (up to 12 weeks)
Caregiver Leave
Adoption and surrogacy reimbursement
As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.