Manager, Revenue Integrity

POSITION SUMMARY:

Under general direction from the Corporate Director, Revenue Cycle – the Manager, Revenue Integrity leads organizational initiatives related to Chargemaster, Facility Coding, Professional Coding, Charge Capture, Charge Reconciliation, Physician Documentation, Payer-specific Coding Requirements, and/or State-specific Coding Requirements. The Manager of Revenue Integrity will develop and maintain relationships with external and internal stakeholders and foster improvements collaboratively across the organization.

JOB SPECIFIC RESPONSIBILITIES:

• Maintain utmost level of confidentiality at all times.
• Adhere to health system policies and procedures.
• Demonstrate ethical business practices and personal actions and adhere to corporate compliance and integrity guidelines.
• Maintains a sense of professionalism and self-validation.
• Ability to communicate effectively with all stakeholders across the health system.
• Responsible for promoting adherence to applicable State/Federal laws and regulations and the program requirements of accreditation agencies and Federal/State and private health plans in requests for third-party reimbursement.
• Evaluate the use of Revenue Cycle electronic systems and offer recommendations to maximize reporting and Revenue Integrity accuracies.
• Acts as a Revenue Integrity liaison with various IT teams handling various EMR modules to set up and maintain accurate charges flow.
• Coordinates the administrative, legal, operational, and financial issues related to Revenue Integrity data with appropriate departments
• Participate and lead the development and management of Revenue Integrity projects, workflows, and application builds.
• Assist with the strategic and financial judgment necessary for profitable organizational growth.
• Responsible for timely research and evaluation of Medicaid and Medicare regulations, as well as Commercial Payer regulations and changes to optimize reimbursement
• Supports and participates in continuously assessing and improving the quality of care and services provided.
• Performs Inpatient and Outpatient coding, including, but not limited to, DX, DRG, CPT, HCPCS, Modifiers, etc.
• Ensures codes are accurate and sequenced correctly in accordance with government and insurance regulations.
• Audits clinical documentation and coded data to validate documentation support services rendered for reimbursement and reporting purposes.
• Participate in denials and appeals related to coding or clinical documentation.
• Develop and maintain a Revenue Integrity policy and standard operating procedures.
• Develop and maintain a Charge Description Master (CDM) for administered services and procedures.
• Identifies KPIs for Revenue Integrity initiatives and collaborates with key stakeholders towards process improvements.
• Identifies and interprets trends and patterns within Revenue Integrity and recommends resolution
• Participate in new service or business line research and assessments.
• Assists and participates in the development of department policies.
• Develops and maintains revenue Integrity reporting.
• Perform extensive data mining and testing of financial and clinical information from various decision support tools and software, as needed, for effective and accurate department reporting.
• Maintains positive working relationships with other organizational departments such as Accounting & Finance, HIM, Compliance, and the Medical Staff to ensure the departments' responsibilities are performed expeditiously and thoroughly.
• Performs other duties as assigned.

POSITION QUALIFICATIONS:

EDUCATION:

• Associate’s Degree in Nursing (RN) or Bachelor of Science in Nursing (BSN)

EXPERIENCE:

• Minimum three years experience in the same or similar position.

LICENSURE/CERTIFICATION:

• Current Core Inpatient Coding Certification from AAPC or AHIMA, such as CIC or CCS
• CPP desired
• Must pass a criminal background check on an annual basis.