Job Summary:

Reporting to the Director of Network Revenue Integrity, responsible for oversight of Revenue Integrity in the WMC Health System. The Manager of Revenue Integrity is responsible for development, coordination, implementation of revenue integrity functions.

Responsibilities:

• Monitor and assess integrity risks, and ensure that the revenue integrity program is responsive to
• those risks. Conducts root-cause analyses with others to identify opportunities for error reduction.
• Lead the enhancement of charge captures activities via the integrated revenue cycle applications, and ensure that the CDM accurately reflect services and supplies provided and are consistent with current industry best practices
• Researches regulatory requirements relevant to charges, monitors trends, and maintains knowledge of charge-related regulations and standards. Applies knowledge to ensure that charges are accurate, billed correctly, and supportable according to payer and regulatory requirements
• Actively participate in committees addressing and/or responsible for revenue integrity activities
• Provide weekly and monthly reports to the revenue integrity director regarding the nature, progress, and status of the revenue integrity program, any corrective action 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
• Lead regular internal staff meetings
• Train, mentor and evaluate staff
• Assure staff is meeting or exceeding individual and departmental goals, and implement performance improvement plan.
• Perform facility charge related internal audits, and respond to external audits (including Compliance and third-parties)
• Oversee outpatient medical denial process, and perform appeals to promote efficiency and revenue optimization.
• Provide oversight and direction to Revenue Integrity facility staff related to special projects

Qualifications/Requirements:

Experience:

Prior experience with auditing and internal controls review in healthcare strongly preferred. General knowledge of healthcare revenue cycle including familiarity with reimbursement methodologies, coding, CDM, charge capture, and billing processes. Understanding of compliance issues, their importance and consequences. Demonstrated leadership ability including ability to work in a team, build consensus, problem-solve, influence others outside a direct reporting relationship, and handle conflicts with tact. Ability to work effectively and coordinate the activities of outside consultants. Requires strong technical skills including use of e-mail, spreadsheets, word processing, databases, decision support system, EHR applications, internet searches for research, project management, and reporting.

Education:

Associate Degree in Accounting, Finance or related field, with minimum of 4 years of experience in Healthcare

Finance, Billing, and/or Internal Audit functions, required. Bachelor's degree, preferred.

Licenses / Certifications:

Coding certification highly preferred.