Revenue Integrity Manager ( Nurse Audit)

The Revenue Integrity Manger is responsible for monitoring and ensuring accuracy of charge workflows in accordance with industry best practices within local, Federal, and State regulations and guidelines. Incumbent is responsible for charge audit to identify root causes of over or under billed charges to minimize charge integrity/compliance risks. Additionally, the Revenue Integrity Manager is responsible for charge reconciliation and creating supporting workflow that are efficient and increase charge capture.The Revenue Integrity Manager will also serve as a liaison to facilitate charge education and compliant charge process improvements.

Responsibilities for Internal Candidates

• Conducts comprehensive charge audit, charge analytics, researches root causes, and recommends solutions to improve workflows, increase efficiency, and reduce revenue leakage. Utilizes analytics to identify missing charges, verify charge integrity or compliance issues.
• Monitor daily reconciliations at the facility level department charge reconciliations, and regularly audits the room and bed accommodation charges. Works closely with IT and other departments to automate and maintain charge reconciliations.
• Monitor late charges and investigate root causes to streamline processes for timely charge entry to avoid revenue and billing delays. Works closely with IT and other departments to automate and maintain late charge reporting.
• Reviews daily Revenue Integrity DNFB assignments & suspense report for items requiring charge audit review and communicates the needed charge corrections to the appropriate department.
• Functions as Revenue Integrity Liaison between the CBO, HIM, Allscripts, Nursing, Compliance, and other departments to facilitate charge related process improvements, education, and charge compliance.

Qualifications for Internal Candidates

Minimum Education: Bachelor’s degree and/or relevant Clinical or Revenue Integrity experience preferred.

Minimum Experience: Five (5) to Seven (7) years Revenue Integrity experience in Charge Audit, Charge Capture, Charge Compliance required. Must be able to effectively communicate verbally and in written formats.
Computer literacy and proficiency required. Knowledge of CPT, ICD10, HCPCS Coding Structure required.
Extensive understanding of CCI edits, CPT, HCPCS, ICD-10-CM, and Revenue codes required. Extensive knowledge of Revenue Cycle and Revenue integrity Processes, Registration, Medical Records Coding, Government, and Managed Care billing rules, coverage, payment, and compliance required. Must demonstrate expert customer service skills

Preferred Certification/Licensure: RN, LVN, CPC, CHRI, CRIP or other Revenue Integrity Certificationpreferred.

Job Type: Full-time

Pay: From $93,800.00 per year

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Work Location: Remote