Manager Revenue Integrity and Analytics

Manager Revenue Integrity and Analytics     

Job Code: 28385    

Position Summary

Provides leadership and direction to teams monitoring and auditing the accuracy of coding and billing processes.  Acts as a liaison for hospital departments and physician groups to ensure compliance with billing and reimbursement contracts.  

Responsibilities

•    Provides leadership in researching and implementing best practice for patient friendly financial interactions 

•    Directs and supervises assigned personnel in their day-to-day tasks including scheduling, orientation and training for new staff, assigns Work queues assignments and monitors productivity and quality

•    Assists in the analysis and monitors the charge master structure and charging practices to ensure system wide compliance with federal, state, and local regulations for charge codes and related information in the CDM 

•    Acts as subject matter expert on current federal, state, and local charging guidelines, coding and billing requirements 

•    Reviews all assigned edits and denials within prescribed timeframe and routes to appropriate owner for resolution working closely with the Revenue Cycle teams to trend from the root cause 

•    Supervises the regulatory coding and billing support to Clinical Charge Capture Specialists (CCCS) to address Charge Description Master (CDM), coding, charge capture and billing questions 

•    Performs modeling and analysis in the build of organization-wide pricing strategy processes 

•    Performs analysis for missing charge capture and pricing as necessary 

•    Supervises department-specific review of capture analysis and provides feedback to clinical department management 

•    Assists in the research for the financial impact of annual CMS regulatory changes 

•    Knowledgeable of payer strategies based on third party publications, including Blue Shield, Medicare, Medicaid, commercial insurers and HMOs/PPOs 

•    Collaborates with departments for charge capture and reimbursement issues, provides and/or assigns education, and assists with remediation 

•    Performs other related duties as assigned 

•    Familiar with standard concepts, practices, and procedures within the field 

•    Relies on experience and judgment to plan and accomplish goals 

•    Regular and predictable attendance is an essential job function

•    Competent to meet age specific needs of the unit assigned

Requirements and Minimum Qualifications

•    Bachelor’s degree required; relevant certification and 5 years related experience may be accepted in lieu of a bachelor’s degree 

•    Continuing education and certification following hire strongly encouraged 

•    Minimum 5 years’ healthcare financial experience required 

•    2 year’s revenue integrity experience preferred 

•    Previous financial healthcare experience required with healthcare analytics and/or financial decision support preferred 

•    Previous lead or supervisor experience preferred 

•    Strong analytical and problem-solving skills; able to perform independently, using sound judgment and SQL queries 

•    Demonstrated knowledge of gross and net revenue impact of pricing strategies 

•    Experience with commercial and government billing, and reimbursement methodologies

Working Conditions

•    Must be able to maintain a sitting position

•    Typical equipment used in an office job

•    Repetitive movements