Job DescriptionReporting to the Revenue Integrity Director, the Manager of Revenue Integrity works collaboratively with others to optimize workflows and related information systems to help ensure accurate, complete, timely documentation, charges and coding of services. The Manager of Revenue Integrity must maintain extensive knowledge of all aspects of the revenue cycle including the registration, documentation, coding, billing and collection processes as well as government and payer regulations for both professional and facility billing. This position is responsible for the analysis and assessment of diverse data relating to the revenue cycle. This Manager provides essential quality reports and improvement recommendations to management for all clinical service lines and revenue cycle departments.
Responsibilities- Helps ensure adequate training and education occurs to both providers and hospital departmental staff regarding accurate charge capture and documentation requirements.
- Oversees Charge Reconciliation, CDM Management and Charge Capture processes and training materials.
- Oversees CDM maintenance and development, including correct coding and charging, updating of pricing, adding new service lines, inactivating unused CDM service lines within established organizational Policy and Procedures. Works directly with managers and other key staff of revenue producing departments to identify billable services, and establish the charge process.
- Develops, documents, and maintains effective charging policy, procedures and training materials (as needed), for the organization.
- Participates in research of billing and coding requirements when new procedures and/or supplies are introduced. If appropriate to bill for new services, ensures related systems are set up correctly, tested, and monitors initial charging of services for proper billing as well as following claims for initial reimbursement.
- Collaborates with clinical leaders and others to review and evaluate new technologies and formulary items and establishes related documentation, charge capture, and coding protocols.
- Liaises with key stakeholders including Finance Departments, Compliance, HIM, Coding, CDI, Clinical Departments, Information Technology, as well as others.
- Facilitates the dissemination of information regarding government and third-party payer regulations and requirements to clinical departments, providers, management and staff, as applicable.
- Oversees communication of coding and billing updates published in third-party payer newsletters/bulletins and provider manuals to all stakeholders as appropriate.
- Works collaboratively with Professional Coding, Facility Coding and Compliance (when indicated) with performing appropriate reviews, investigating trends and patterns, and providing education regarding documentation, charge capture, charge reconciliation, billing/coding guidelines and denials. Ensures reviews are conducted on an annual basis and/or as otherwise identified, in all areas treating patients to ensure all professional and facility billable charges are captured and coded completely and accurately, and documentation reflects same.
- Maintains knowledge of government and third-party payer audits and participates in denials prevention activities.
- Maintains a revenue optimization database, communicates and coordinates resolution of opportunities. Presents and communicates findings, trends, mitigation efforts and recommendations to established Committees and key stakeholders.
- Assists and makes recommendations for third-party payer contract language related to clinical coding standards and requirements. Participates in internal and external contracted payer discussions and negotiations regarding clinical coding and charging standards when needed.
- Develops and monitors metrics to ensure functions of the Revenue Integrity team are performed efficiently as well as with a high degree of accuracy and customer service.
- Coordinates external reviews for focused assessments as well as information system software review (CDM, Supply, Medications).
- Demonstrates support for the mission, values and goals of the organization.
QualificationsMinimum Education and Experience Required- Bachelor's degree in Healthcare related field, Master's Degree Preferred. May maintain an Associate's degree with 10+ years' experience directly related to healthcare and Revenue Integrity in lieu of a Bachelor's degree.
- Required: Seven years minimum recent and direct related experience. Previous management experience in Clinical service area(s), Revenue Integrity, Revenue Cycle Area(s).
- Strongly Preferred: Previous clinical experience.
License and/or CertificationRequired:
- Active Certified Coding Specialist (CCS) and/or Certified Professional Coder and/or Certified Outpatient Coder and/or Hospital (CPC-H) (or attainment within one (1) year of hire).
Preferred:
- Dual Certifications i.e., CPC and CCS
Knowledge, Skills, and AbilitiesKnowledge of:
- Extensive clinical coding knowledge; clinical experience preferred.
- Solid understanding of the reimbursement systems including IPPS, OPPS, DRG, etc.
- State and federal and third party payer regulations.
- CPT/HCPCS/ ICD classification, medical terminology, billing and reimbursement processes.
- Extensive knowledge of charge creation, processing and reconciliation in a health care environment.
Skilled at:
- Strong quantitative, analytic, and problem-solving skills.
- Strong organizational skills.
- Strong time management, attention to detail, and follow through.
- Excellent interpersonal and communication skills.
- Microsoft Office, Outlook, Excel; Epic experience highly desirable.
- Well developed, formal presentation skills.
Ability to:
- Effectively collaborate with providers and staff at all levels.
- Manage day to day operations managing staff and ensuring efficient workflows
- Analyze and interpret billing guidelines, state, federal and third party payer regulations.
- Organize resources and establish priorities.
- Develop, plan and implement short and long-range goals.
- Foster a cooperative work environment.
- Effectively manage staff, ensure employee development and oversee performance management
About UsConnecticut Children's is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children's offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity and inclusion provide a welcoming and inspiring environment for our patients, families and team members.
At Connecticut Children's, treating children isn't just our job - it's our passion. As a leading children's health system experiencing steady growth, we're excited to expand our team with exceptional team members who share our vision of transforming children's health and well-being as one team.
