Yale-New Haven Hospital

Manager, Revenue Integrity

Yale-New Haven Hospital • $100K — $120K *
New Haven, CT 06511In-Person
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's degree in Finance, IT, or related field required; Master's preferred.
  • Minimum of 5 years of progressive experience in Revenue, Billing, or Finance in a healthcare setting.
  • RN License, Coding Certification, or Epic Resolute Certification preferred.
  • Strong verbal and written communication skills.
  • Excellent analytical and interpretive skills.

Responsibilities

  • Manage system charge capture and nurse audit teams for all assignments.
  • Enhance business practices for compliant charge capture processes and appropriate reimbursement.
  • Lead initiatives to improve net revenues and compliance through team education on regulations.
  • Collaborate with Charge Description Master Manager on coding and billing guidelines updates.
  • Develop and execute educational programs on revenue cycle issues with various teams.
  • Maintain relationships with revenue-generating departments and clinical services.
  • Act as a liaison between clinical and finance for new service lines and regulatory changes.

Benefits

  • Collaborative working environment across and within healthcare sectors.
  • Opportunities for professional development and continued education.
  • Flexibility in work assignments and responsibilities related to revenue cycle.
  • Engaging in team-oriented problem-solving and process improvement initiatives.
Full Job Description
Overview

The Manager, Revenue Integrity is responsible for identifying and developing strategies which will optimize reimbursement across the Yale New Haven Health System. With support from key areas throughout the Delivery Networks, this position will recommend and coordinate implementation of process improvements, revenue enhancement initiatives for the revenue cycle, and educating departments, clinicians and revenue cycle participants on coding, billing and reimbursement regulations to ensure appropriate reimbursement in a compliant manner.

Responsibilities

  • Manage system charge capture / nurse audit teams, on all projects and assignments.
  • Manage an enhanced business practice model that supports appropriate reimbursement and compliant charge capture processes.
  • Improve systems net revenues, revenue compliance and cash collections by optimizing the system wide revenue cycle. Lead the team to ensure revenue, billing, charging and coding compliance through education of hospital personnel on current and changing regulations.
  • Work collaboratively with the Charge Description Master Manger to ensure CDM is updated to reflect appropriate coding and billing guidelines as well current insurance contracts.
  • Participate collaboratively with System Billing Office, EPIC HB, and Denials Management teams in the development, execution and follow-up of education programs for the healthcare system on all issues related to the revenue cycle.
  • Develop and maintain collaborative working relationships with revenue producing departments, information systems personnel and clinical services.
  • Act as a liaison between clinical and finance departments when new service lines are created or regulations are updated that affect current service lines.
  • Perform on-site analysis of processes and Revenue Cycle Management as well as conducting follow up analysis of post-implementation operations.
  • Perform charge capture audits.
  • Identify root causes of charging practices and deficiencies to effectively address changes needed.
  • Perform defense audits upon notification of external governmental audits.
  • Follow up on issues uncovered during internal or external audits.
  • Provide coding expertise for all compliance and reimbursement issues.
  • Maintain up-to-date knowledge of regulatory (federal, state, and third party payer) requirements and changes impacting charging practices.
  • Perform all other duties as assigned.

Qualifications

EDUCATION
  • Bachelor's degree in Finance, IT or related field is required. Master's Degree preferred.

EXPERIENCE
  • A minimum of 5 years of progressive experience working in a Revenue, Billing and/or Finance discipline within a healthcare setting.

LICENSURE
  • RN License, Coding Certification or Epic Resolute Certification preferred.

SPECIAL SKILLS
  • Excellent verbal and written communications skills.
  • Strong computer skill with the ability to work independently and meet crucial deadlines.
  • Ability to perform multiple tasks within time frame.
  • Excellent interpersonal skills with the ability to relate well, communicate effectively, and interact with all levels of management, employees and outsiders.
  • Strong analytical and interpretive skills.
  • Current knowledge of reimbursement requirements necessary for Third Party payers including Medicare, Medicaid, and Commercial plans.
  • Knowledge of medical coding, billing and Federal/State regulations.


YNHHS Requisition ID

186507

About Yale-New Haven Hospital

Yale-New Haven Hospital is a non-profit hospital that provides healthcare services to patients in Connecticut and beyond. The hospital was founded in 1826 and has since grown to become one of the largest and most respected hospitals in the region. Yale-New Haven Hospital is dedicated to providing high-quality, patient-centered care to all patients, regardless of their ability to pay. The hospital offers a wide range of services, including emergency care, surgery, cancer treatment, and more. Yale-New Haven Hospital is committed to advancing medical knowledge through research and education, and is affiliated with Yale University School of Medicine.
Learn more about Yale-New Haven Hospital
Size
12,000 employees
Industry
Healthcare
* Ladders Estimates

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