Full Job Description
Job Summary
The Manager of Revenue Integrity manages all Revenue integrity & charge capture activities, and is responsible for performance and effectiveness of the department. The Manager will be responsible for implementing short and long-term plans and objectives to ensure resolution of revenue integrity edits in Epic within set deadlines, ensure compliant charge capture practices, ensure claims timely filing, & reduce denials. Additionally, they will work with all departments within the Revenue Cycle to manage DNFB, coordinate efforts and ensure timely payments by insurance companies. They will empower staff to develop methods of process improvement, including planning, setting priorities, conducting systematic performance assessments, implementing improvements based on those assessments and maintaining achieved improvements. Set standards of behaviors and performance for the department based on the Ensemble Difference principles.
Job Functions
Manages all revenue integrity activities performed by staff across all Ensemble clients. Staff responsibilities include resolving revenue integrity edits to send claims to insurance companies for timely payment, identify trends and issues related to charge capture practices, educate clinical staff on appropriate charge capture and revenue reconciliation processes. Working with other departments within the Revenue Cycle to ensure compliant charging and billing practices, identify trends in charge capture errors, and provide necessary education to facilitate accurate charging and billing. Attend and coordinate department weekly & monthly meetings.
Responsible for interviewing, hiring, staffing, performance management and development of staff. Counsels and disciplines employees when necessary in accordance with department and/or
organizational policies. Develops and maintains the training and education program for new hire and for existing staff. Develops, updates and implements job standards, job duties, departmental policies and performance appraisals for all areas of responsibility.
Prepares monthly analytics reports as requested by management. Establishes departmental goals with the staff to optimize performance and meet budgetary goals while improving operations to increase customer satisfaction and meet financial goals of the organization.
Collects, interprets and communicates performance data using various tools and systems, while also using this data to make decisions on how to achieve performance goals. Works with internal and external customers to make key decisions, impacting either the organization or an individual patient. Works closely with ancillary departments to establish and maintain positive relations to ensure revenue cycle goals are achieved.
Assists in strategic planning and performs ongoing process improvement evaluation. Reviews, updates and implements policies and procedures to support the vision and goals.
Employment Qualifications
Legally Required License / Certification (Ex: MD, RN, LPN, etc.) ONE CERTIFICATION PER FIELD
Ensemble Required License / Certification (Ex: CRCR) ONE CERTIFICATION PER FIELD - CRCR through HFMA, Coding certification or equivalent Or other approved job relevant certification.
5 to 7 Years - Overall work experience
3 to 5 Years - People leadership experience
Education Level - High School Diploma, GED, or Equivalent Experience
General Office Environment or Work From Home - No
Other Preferred Knowledge, Skills and Abilities
• Required Minimum Education - Specialty/Major: Business or Health care field
• Preferred Minimum Education: 4 year/ Bachelors Degree
• Preferred Minimum Education - Specialty/Major: Business or Healthcare field
• Minimum Years and Type of Experience: 5 or more years of experience in Revenue Integrity or Revenue Cycle Operations
• Other Knowledge, Skills and Abilities Required:
• Experience in Healthcare operations, Revenue Cycle Operations, Charge Capture, Billing
Salary: $84K to $110K depends on experience, skills, education, interview and other qualifications
