Physician Revenue Integrity Manager

Location: Kent Campus Hospital, Dover Delaware

Status: Full Time 80 Hours Biweekly (Exempt)

Shift: Days

SALARY RANGE: 89,273.60 - 138,361.60 YEARLY

General Summary:

Responsible for directing, coordinating, and planning of staff to optimize revenue for physician practices. Oversee charge capture and reconciliation, professional billing compliance and revenue optimization for physician practices. The Revenue Cycle Manager works closely with the Practice Managers, Senior Management, Central Billing Office, and other key personnel, to define and implement the resolution of healthcare revenue flow. Adhere to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state, and private health plans. Leads by example following all Bayhealth values holding team members and payers accountable. Ability to work independently and meet established deadlines, develop reports and quantify denial issues impacting AR performance. Excellent communicator and agent for change.

Responsibilities:

1. Supervises directly or indirectly, exempt and nonexempt personnel engaged in the department. This includes interviewing, hiring, performance evaluation, training and disciplining all system support personnel. Delegates authority as determined appropriate.
2. Provides a goal-oriented work environment, establishing clear and concise work expectations. Develops and plans goals and objectives for the department with PFS and Physician Leadership Team. Measures financial and operational performance, maintains monitoring and reporting systems. Audit, trend and benchmark billing/collection functions.
3. Manage charge capture and reconciliation processes for all clinicians submitting professional fee claims. Ensuring encounters are closed in accordance with Bayhealth policy. Communicates charge capture and revenue issues to PFS and Practice Leadership. Monitors vendor performance, as appropriate, for any outsourced coding services.
4. Oversees Operations Analyst responsible for claims, accounts receivable, payment variance and denial management analytics. Validates root causes and identifies mitigation opportunities. Presents monthly trending reports to Physician Revenue Cycle leaders discussing options to improve performance.
5. Oversees physician Revenue Cycle analyst ensuring monthly reports are completed timely.
6. Manages the coding audits and auditor performance. Compiles and distributes monthly reports to respective leaders regarding audit results. Provides necessary education/training to address opportunities for improvement. Implement technology efficiencies in current auditing process to sustain performance under growth.
7. Complete monthly rounding on direct reports; maintain individual rounding logs and stop light reports to facilitate communication. Promotes employee engagement for individual teams and the department is striving for continues improvement.
8. Serves a primary point of contact for physician practice leadership questions. Research concerns through to resolution. Collaborates with practice managers, compliance officers and revenue cycle peers to resolve issues.
9. As applicable, maintains all Epic ARCR certifications in good standing.
10. Reviews all requests for system changes to determine the impact on payers and processes under the position's span of control. Ensures supporting research and documentation supporting the change request are accurate and have been properly validated.
11. All other duties as assigned within the scope and range of job responsibilities.

Required Education, Credential(s) and Experience:

• Education:
• Bachelor Degree Business
  ; In lieu of a bachelor's degree, may accept a High School Diploma or GED with eight (8) years of Revenue Cycle Progressive leadership experience. (Four years of experience for a verified associate's degree.)
• Credential(s): None Required
  ;
• Experience:
  Required: Five years of physician revenue cycle experience. Three years in a supervisor role.
  Preferred: Seven years of physician revenue cycle experience. Five years in a supervisor role.

Preferred Education, Credential(s) and Experience:

• Education:
• Credential(s): Certified Revenue Cycle Representative
  Certified Patients Account Manager
• Experience:

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