The Revenue Integrity Supervisor is responsible for overseeing West revenue integrity processes to drive appropriate reimbursement, pricing accuracy, transparency and expertise for charge capture.
You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Las Vegas , you will be required to work in the office a minimum of 2 times a month or PST working hours 8 am to 5pm Monday Thru Friday
Primary Responsibilities:- Supervises daily revenue integrity operations, including payer payment and pricing applications, charge control processes, system updates as needed
- Maintains the chargemaster and fee schedules for West Region; completes annual and quarterly updates; documents approved changes; and coordinates annual CDM CPT/HCPCS updates
- Monitors charge-capture controls, including revenue reconciliation, change management, and supports departmental accountability for complete and accurate charges
- Reviews, works, and resolves Epic charge-related work queues and billing edits accurately and within established turnaround times
- Partners with Coding and clinical departments to identify and correct charge, billing, documentation, and coding errors in accordance with ICD, CPT, HCPCS, payer, and National Correct Coding Initiative requirements
- Serves as the primary service-line resource for charge-related questions, charge-code use, payer coverage, and payment requirements
- Identifies opportunities to optimize practice management and revenue cycle technology, integrate business intelligence tools, automate manual processes, and standardize reporting across the West
- Analyzes, validates, and distributes KPI dashboards, quality-control reports, monthly operational reports, and ad hoc analyses for Revenue Cycle, Finance, Clinical Operations, and other stakeholders
- Analyzes charges, payments, denials, and reimbursement trends to identify revenue gaps, short payments, noncompliance, and opportunities to accelerate collections and prevent revenue loss
- Conducts routine claim and chargemaster reviews, coordinates complex denials and payer audits, and escalates or troubleshoots claim and reimbursement issues with payers
- Monitors Medicare, Medicaid, and commercial payer guidance and medical policies; evaluates operational and financial impacts; and implement approved compliance changes with Revenue Integrity and operational leaders
- Meets with operational leaders to review revenue cycle metrics, identify trends and issues, and develop interim and long-term improvement plans
- Supports payer contract configuration in practice management systems and monitors payments against contractual terms to identify reimbursement variances
- Participates in revenue cycle improvement initiatives and completes other duties or projects that support organizational goals
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- 2+ years of experience in Healthcare Revenue Cycle Operations including revenue integrity, reimbursement methodologies, denials, and process improvement
- 2+ years of experience in advanced analytics, delivering actionable insights from data, databases, and big data analytics environments
- Working knowledge of medical coding (ICD, CPT, HCPCS)
- Exposure to healthcare data from multiple sources: Payor claims processing, EDI, EHR
- Experience in working with multi-disciplinary teams and varying levels of leadership
- Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization process
- Intermediate proficiency with Microsoft products such as Excel, PowerPoint, Word, Project
- Solid problem-solving, critical thinking, and analytical skills
- Demonstrated comprehension of complex clinical and revenue integrated systems and processes
- Solid & efficient communication and customer service skills
Preferred Qualifications:- Ability to take direction from senior leadership but also be able to work independently with follow-through and handle multiple tasks simultaneously
- Solid verbal skills and ability to communicate abstract concepts in a simple format
- Solid organizational skills: ability to prioritize work; detail oriented
- Ability to educate and train all levels of professional staff
- Ability to be proactive, self-directing, and take initiative
- Ability to work efficiently under pressure
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
