Manager Revenue Integrity

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Lead and oversee the daily operational management of revenue integrity functions at local hospitals.

• Inspire and drive staff towards high performance while partnering with stakeholders to minimize revenue loss and enhance regional revenue.

• Oversee the Charge Description Master, implement pre-bill edits, conduct root cause analysis, coordinate denials with PBS, manage complex case denials, prevention of denials, audits, and provide education and training.

• Identify and manage opportunities for revenue optimization, including charge control processes.

• Improve staff and revenue performance by redesigning processes, implementing policies and procedures, enhancing communication, and providing continuing education, professional development, empowerment, and feedback.

• Ensure comprehension and application of payer contract terms and ensure alignment with operational processes.

• Track updates from Medicare, Medicaid, and other payer websites and newsletters that impact charging, coding, and billing; implement changes for compliance and revenue optimization.

• Manage denials from the Patient Business Service center, ensuring timely resolutions, identifying root causes, and engaging in multidisciplinary denial teams.

• Collaborate with various departments to identify and address causes of denials and pre-bill edits to optimize revenue.

• Develop and deliver educational sessions focusing on audit findings, regulatory changes, coding updates, and managed care billing requirements.

• Create colleague schedules and oversee team projects while nurturing interdisciplinary relationships.

• Involve interdisciplinary and medical staff in decision-making processes and coordinate problem-solving and corrective actions.

• Evaluate departmental development needs and advocate for professional development, orientation, and continuing education.

• Recruit new employees, manage resource allocation, conduct performance reviews, provide feedback, mentor and coach team members, and oversee disciplinary actions.

• Analyze and present data, develop policies and business documentation, conduct special studies, and prepare management reports and KPIs.

• Stay informed about relevant laws, regulations, and Trinity Health compliance policies and the Code of Conduct.

⛳️ Requirements

• Bachelor's degree in finance, Business Administration, or a related field, along with a minimum of 5 to 7 years of progressively responsible experience in revenue cycle operations, specifically in revenue integrity, or an equivalent combination of education and relevant experience.

• At least 3 years of management experience within a multi-facility, integrated healthcare delivery system, or experience in revenue cycle or revenue integrity consulting.

• Proven knowledge and experience in revenue integrity within an acute care setting.

• Strong comprehension of appeals, denial management, medical necessity, and coding audits.

• Ability to interpret medical charts and documentation to correlate services with charges on claim forms (UB and/or 1550 forms).

• Preferred credentials include RHIA, RHIT, CCS, CPC/COC, or other coding certifications.

• CDC (Healthcare Compliance Certification) is preferred.

• Experience in the maintenance or oversight of the Charge Description Master (CDM) is preferred.

• Ability to organize, plan, and manage staff involved in Revenue Integrity and Optimization activities within a large healthcare acute and professional billing organization.

• Familiarity with laws and payer contracts related to billing for hospital and/or physician services.

• Capacity to work effectively with physicians, clinicians, office managers, administrators, third-party payers, governmental agencies, and colleagues.

• Capability to understand and interpret complex issues and clinical processes, providing recommendations for improvements.

• Experience in data collection, analysis, and the preparation of written reports and proposals.

• Strong understanding of DRG, APC, OPPS reimbursement structures, and pre-bill edits, including OCE/CCI edits and DNFB.

• Ability to excel in a fast-paced, multi-client environment with competing needs and potentially varied and extended hours.

🏝️ Benefits

• Remote work opportunity.

• Continuing education and professional development activities.

• Opportunities for colleague orientation and ongoing education.

• Equal Opportunity Employer.