Manager, Revenue Integrity & Optimization – Acute/Professional

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

📋 Description

• Provide leadership and oversee daily operational management for local hospital and/or Medical Group Provider Services revenue integrity functions.

• Inspire staff to reach high performance levels and prevent revenue loss while maximizing regional revenue.

• Manage the Charge Description Master, pre-bill edits, denial coordination, complex case denials, denial prevention, audits, education, and training.

• Oversee revenue optimization initiatives, including charge control processes.

• Collaborate with Revenue Integrity and Payer Strategies leadership to implement payer contract terms and streamline processes.

• Monitor Medicare, Medicaid, and other payer websites and newsletters for updates that impact charging, coding, and billing.

• Coordinate denials from the Patient Business Service center and lead root-cause analysis and resolution efforts.

• Work with multidisciplinary teams to address process and system challenges and enhance revenue.

• Prepare and deliver education on audit findings, regulatory changes, coding updates, and managed-care billing requirements.

• Develop colleague work schedules and oversee team projects and staffing.

• Gather interdisciplinary feedback, resolve issues, and coordinate corrective actions.

• Evaluate departmental development needs and foster decision-making, communication, interpersonal skills, orientation, and continuing education opportunities.

• Recruit employees, allocate resources, conduct performance evaluations, provide feedback, mentor and coach colleagues, and manage disciplinary procedures.

• Analyze and present data, create policies and procedures, conduct special studies, and prepare management reports and KPIs.

• Maintain an understanding of applicable laws, regulations, and Trinity Health compliance policies.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor's degree in Finance, Business Administration, or a related field, with 5–7 years of progressively responsible experience in revenue cycle operations, including revenue integrity, or an equivalent combination of education and progressive revenue cycle experience.

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

• Knowledge and experience in revenue integrity within an acute care and/or physician practice setting.

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

• Ability to read medical charts and dictations and correlate services to charges on UB and 1500 claim forms.

• RHIA, RHIT, CCS, CPC/COC, or other coding credentials are preferred.

• CDC (Healthcare Compliance Certification) is preferred.

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

• Ability to organize, plan, and manage staff in Revenue Integrity and Optimization activities.

• Knowledge of laws and payer contracts related to hospital and/or physician service billing.

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

• Ability to interpret complex issues and clinical processes and recommend improvements.

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

• Strong knowledge of DRG, APC, OPPS reimbursement structures, OCE/CCI edits, and DNFB.

• Ability to concentrate, meet deadlines, manage multiple projects, adapt to interruptions, organize changing priorities, and thrive in a fast-paced environment.

🏝️ Benefits

• Remote work position.

• Day shift.

• Professional development activities.

• Continuing education opportunities.

• Colleague orientation and training opportunities.

• Equal Opportunity Employer.