Registered Nurse Manager Revenue Integrity Audit Recovery and Appeals

Job Description:
The Manager, RN Revenue Integrity Audit, Recovery and Appeals organizes and manages the daily operations of the Audit and Recovery teams in the Revenue Service Center (RSC) reporting directly to the Sr. Director, Revenue Integrity. The region-wide manager is responsible for the team's performance coordination and responses to commercial and government requests, denials and recoupment efforts. Additionally, the Manager will support coordinating efforts on clinical denials for medical necessity when needed and collaborate with external stakeholders for optimal account resolution
Scope

Reports to the Senior Director, Revenue Integrity

Job Essentials

• Manages the government and commercial payer audit and recovery programs, solicits feedback, and implements solutions.
• Proactively identifies potential adverse audit outcomes, revenue leakage and develops plans to address opportunities.
• Maintains knowledge of government and payer audits practices, trends, and compliance related topics. Partners with clinical areas and revenue cycle areas affected by the changes in the industry.
• Provides ongoing education and training on best practices for areas of oversight and acts as a content knowledge resource to Intermountain.
• Manages the workflows and practices across a multi-disciplinary team.
• Manage large projects through multi-disciplinary teams; specifically related to high dollar and high volume clinical denials.
• Develops and maintains new policies, procedures and guidelines for the department.
• Manage the daily operations of department and collaborates with the department management team in planning, program development, human resource management, budget planning, customer satisfaction, patient safety, communication and compliance with regulatory agencies.
• Evaluates service needs and volumes and adjusts staffing levels accordingly and maintains effective and appropriate staffing and staff scheduling to ensure safe, quality patient care. Promotes staff flexibility and cross-training.
• Provides communication to team through rounding, huddles, staff meetings and other forms of communication to relay updates regarding department updates, organizational activities, financial performance, educational opportunities, interdepartmental activities and QI activities.
• Promotes effective working relationships and works effectively as part of a department/unit team and interdepartmentally to facilitate that department's ability to meet its goals and objective.
• Participates in interdisciplinary committees throughout the organization and manage human resource functions such as interviewing, selection, orientation, education/training, feedback, performance evaluation, and policy and procedure development. Maintains personnel files, including documentation of appropriate staff orientation, competency, training, discipline and performance reviews.
• Oversees department timekeeping and payroll and collaborates with HR concerning employee issues and performance. Conducts employee coaching, counselling, disciplinary actions and annual appraisals. Monitors staff adherence to hospital and departmental policies and procedures.
• Participates in fiscal accountability of services, operational and capital planning, annual operating plans, business plans for new services and human resource structure and prepare and present business plans, reports, and other statistical data.

Minimum Requirements

• Active RN License is required in state of practice.
• Ten years of revenue cycle experience in a hospital setting. (Bachelor's Degree in nursing or healthcare related field may satisfy 4 years of the required revenue cycle experience).
• Two years in a professional level leadership role (Supervisor or Above) in a hospital setting.
• Demonstrated skills and experience in Medical Billing, Computer Coding, Business Office, Revenue Cycle,
• Insurance Reimbursements, Leadership, Revenue Integrity and Provider Enrollment.

Preferred Qualifications

• Bachelor's degree in Nursing is preferred.

Physical Requirements:
Interact with others by effectively communicating, both orally and in writing.- and -Operate computers and other office equipment requiring the ability to move fingers and hands.- and -See and read computer monitors and documents.- and -Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.- and -May require lifting and transporting objects and office supplies, bending, kneeling and reaching.

Location:
Peaks Regional Office

Work City:
Broomfield

Work State:
Colorado

Scheduled Weekly Hours:
40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$43.67 - $67.41

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

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All positions subject to close without notice.