US:NV:Carson City Revenue Integrity
Full Time
Summary
The Manager of Revenue Integrity provides leadership and oversight of revenue integrity operations to support accurate, compliant, and complete capture of healthcare services and reimbursement. This position is responsible for managing processes related to charge capture, charge description master (CDM) maintenance, billing and coding integrity, reimbursement optimization, revenue leakage prevention, and regulatory compliance.
The Manager partners closely with clinical, operational, finance, coding, billing, compliance, and information technology teams to identify revenue opportunities, resolve charge and billing issues, improve workflows, and ensure services are accurately represented throughout the revenue cycle. This role provides leadership to Revenue Integrity staff and serves as a subject matter expert and organizational resource for revenue integrity practices.
Qualifications
Required:- Bachelor's degree in Health Information Management, Healthcare Administration, Business Administration, Healthcare Management, or related field, or equivalent combination of education and experience.
- Minimum of five (5) years of progressively responsible experience in healthcare revenue cycle, revenue integrity, hospital billing, billing compliance, coding compliance, reimbursement, auditing, charge capture, or related operations.
- Minimum of three (5) years of progressive leadership, supervisory, project leadership, or program oversight experience.
- Demonstrated knowledge of hospital and/or professional billing requirements, reimbursement methodologies, Medicare, Medicaid, commercial payer requirements, and healthcare revenue cycle operations.
- Working knowledge of CPT, HCPCS, ICD-10-CM, revenue codes, billing edits, charge capture, and healthcare billing and coding compliance requirements.
- Experience analyzing complex revenue cycle issues, conducting audits or reviews, identifying root causes, and implementing corrective actions and process improvements.
- Demonstrated ability to collaborate across clinical, operational, financial, compliance, and technical teams
Preferred:- Master's degree in Healthcare Administration, Business Administration, Health Information Management, Finance, or related field.
- Certified Revenue Integrity Professional (CRIP) or other recognized revenue integrity certification.
- Certified Revenue Cycle Representative (CRCR) or Certified Healthcare Financial Professional (CHFP).
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or comparable coding/auditing credential.
- Certified in Healthcare Compliance (CHC).
- Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).
- Other applicable healthcare revenue integrity, reimbursement, coding, billing compliance, or revenue cycle certification.
- Experience leading or supporting a formal revenue integrity program within a hospital or integrated health system.
- Experience with Charge Description Master (CDM) management, charge capture optimization, billing compliance auditing, and revenue leakage prevention.
- Experience with denial prevention, reimbursement optimization, payer audits, regulatory compliance, and revenue cycle process improvement.
- Experience in a hospital, multi-specialty physician practice, or integrated health system environment.
- Experience with Epic revenue cycle applications, charging workflows, work queues, reporting tools, and revenue integrity functionality.
Essential Functions
- Manages and oversees daily revenue integrity activities to ensure accurate charge capture, compliant billing practices, reimbursement integrity, and timely resolution of identified issues.
- Develops and maintains a comprehensive revenue integrity monitoring program designed to proactively identify revenue leakage, billing compliance risks, charge capture issues, and reimbursement opportunities.
- Oversees billing and coding compliance monitoring and auditing activities and partners with Compliance, Health Information Management, Patient Financial Services, and operational departments to investigate findings and implement corrective actions.
- Serves as a revenue cycle subject matter expert for billing regulations, coding and charging requirements, reimbursement methodologies, payer requirements, and revenue integrity best practices.
- Provides operational billing and coding expertise in partnership with the Compliance team to support consistent interpretation and application of regulatory requirements and mitigate organizational compliance risk.
- Oversees charge capture processes and performs or coordinates reviews to ensure services, procedures, supplies, and medications are accurately and appropriately charged.
- Oversees Charge Description Master (CDM) governance and maintenance, including annual updates, new services, charge codes, CPT/HCPCS mapping, revenue codes, pricing changes, and other regulatory updates.
- Partners with clinical and operational departments to evaluate new services, procedures, technologies, and workflows to ensure appropriate charging, coding, billing, reimbursement, and compliance requirements are established prior to implementation.
- Identifies revenue leakage, workflow deficiencies, system issues, and reimbursement opportunities; develops and implements corrective actions and process improvements.
- Analyzes denial trends related to charge capture, coding, billing, reimbursement, and payer requirements and collaborates with appropriate departments to implement prevention strategies.
- Partners with Patient Financial Services, Health Information Management, Patient Access, clinical departments, Finance, Compliance, and Information Technology to resolve complex revenue cycle and reimbursement issues.
- Partners with EMR and information systems teams to develop, maintain, and optimize charging workflows, edits, work queues, reporting, and system controls that support revenue integrity and billing compliance.
- Develops and monitors key performance indicators, dashboards, audit results, and other reporting to measure revenue integrity performance and identify areas of financial or compliance risk.
- Provides education and guidance to clinical, operational, and revenue cycle teams regarding charge capture, billing compliance, reimbursement requirements, and revenue integrity processes.
- Develops and maintains departmental policies, procedures, standard work, internal controls, and documentation related to revenue integrity activities.
- Supports internal and external audits, payer reviews, regulatory reviews, compliance initiatives, and corrective action plans as needed.
- Participates in recruitment, onboarding, performance evaluations, employee development, and other leadership activities for assigned staff.
- Leads process improvement, workflow optimization, and system enhancement initiatives that support revenue cycle performance, compliance, and organizational growth.
- Performs other related duties as assigned.
