The Revenue Cycle Integrity Manager is responsible for leading and coordinating efforts to ensure accurate, compliant, and optimized reimbursement throughout the revenue cycle. This position serves as the organizational leader for revenue integrity initiatives including denial prevention, charge capture validation, reimbursement analysis, payer compliance, documentation improvement, prior authorization compliance, audit management, and revenue cycle performance improvement.
Essential Duties and Responsibilities- Lead the Revenue Integrity Program and identify opportunities to reduce revenue leakage.
- Analyze denial trends and implement corrective action plans.
- Conduct charge capture audits and monitor charging accuracy.
- Manage Chargemaster governance, updates, and compliance reviews.
- Review payer contracts and reimbursement methodologies.
- Monitor prior authorization compliance and reduce authorization-related denials.
- Partner with HIM, Coding, Billing, Central Scheduling and Clinical Leadership to improve documentation quality.
- Coordinate responses to payers, RAC, and other reimbursement audits.
- Develop dashboards and revenue cycle integrity performance reports.
- Lead cross-functional quality improvement projects throughout the revenue cycle.
Required Qualifications
Bachelor's degree in healthcare administration, finance, business, or related field. Minimum ten years of healthcare revenue cycle experience. Preferred certifications include RHIA, RHIT, CCS, CPC, CDIP, or CHRI.
Knowledge and SkillsKnowledge of healthcare reimbursement, CPT, HCPCS, ICD-10, MS-DRG, APCs, chargemaster maintenance, denial mitigation, payer compliance, and regulatory requirements. Strong analytical, financial, project management, and leadership skills.
Performance Goals and Key Performance Indicators- Reduce preventable denials.
- Achieve authorization compliance of 95% or greater.
- Maintain charge capture accuracy of 98% or greater.
- Complete annual chargemaster review and coding/billing updates.
- Improve clean claim rates and reduce avoidable edits.
- Successfully coordinate payer audit responses with minimal findings.
- Identify measurable reimbursement improvement opportunities.
- Improve documentation quality and coding accuracy year over year.
Benefits SummaryWe are proud to offer a comprehensive benefits package, including:
- Health Insurance
- Medical, dental, and vision coverage options.
- Free internal prescription program
- Employer contributions to premiums.
- Retirement Plans
- 457(b) plan with employer matching.
- 401(a) plan for employer contributions.
- Paid Time Off (PTO)
- Vacation days: 12 to 27 days per year based on years of service
- Sick days: 12 days per year accruing to a maximum of 65 days.
- Holidays: 6 observed paid holidays
- Work-Life Balance
- Other Benefits
- Employer-provided life insurance with optional additional coverage available at the employee's expense.
- Short-term and long-term disability insurance
- Employee assistance programs (EAP)
- Health Savings Accounts
- Flexible Spending Accounts
- Professional development opportunities
- Scholarship and Tuition reimbursement
- Additional Perks
- Wellness programs
- Volunteer opportunities
- Productivity, retention, and referral bonuses
