Job Description

Status

Full-Time

Standard Hours per Week

40

Job Posting Category

Accounting/Finance

Job Posting Description

Manager, Revenue Integrity Program (hybrid)
Key Responsibilities: 1. Helps ensure adequate training and education occurs to both providers and foundations staff
regarding accurate charge capture and documentation requirements.
2. Oversees Charge Reconciliation and Charge Capture processes and training materials.
Develops, documents, and maintains effective charging policy, procedures and training materials
for the PO and Shared Service Center.
3. Works directly with foundations and other key staff of revenue producing departments to identify
billable services and establish the charge process.
4. Participates in research of billing and coding requirements when new procedures and/or supplies
are introduced. If appropriate to bill for new services, ensures related systems are set up correctly, tested, and monitors initial charging of services for proper billing as well as following
claims for initial reimbursement.
5. Liaises with key stakeholders including Foundations, Finance, Compliance, HIM, Coding, CDI,
Clinical Departments, Information Technology, as well as others.
6. Facilitates the dissemination of information regarding government and third-party payer
regulations and requirements to foundations, providers, management and staff, as applicable.
7. Oversees communication of coding and billing updates published in third-party payer
newsletters/bulletins and provider manuals to all stakeholders as appropriate.
8. Works collaboratively with Professional Coding, Foundations and Compliance (when indicated)
with performing appropriate reviews, investigating trends and patterns, and providing education
regarding documentation, charge capture, charge reconciliation, billing/coding guidelines and
denials. Ensures reviews are conducted on an annual basis and/or as otherwise identified, in all
areas treating patients to ensure all professional billable charges are captured and coded
completely and accurately, and documentation reflects same.
9. Maintains a revenue optimization database, communicates and coordinates resolution of
opportunities. Presents and communicates findings, trends, mitigation efforts and
recommendations to established Committees and key stakeholders.
10. Assists and makes recommendations for third-party payer contract language related to clinical
coding standards and requirements.
11. Develops and monitors metrics to ensure functions of the Revenue Integrity team are performed
efficiently as well as with a high degree of accuracy and customer service.
12. Demonstrates support for the mission, values and goals of the organization.

Knowledge of Healthcare Revenue Cycle: Understanding of billing, coding, collections and
regulatory requirements. Strong knowledge of medical billing, coding (ICD-10, CPT, HCPCS) and
payer policies. Working knowledge of financial principles and metrics related to effective revenue
cycle management.

License preferred: Clinical license such as Registered Nurse (RN), Registered Respiratory Therapist (RT), Medical Technologist (MT), Registered Pharmacist (RPh)

Certification preferred: Coding certification such as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or AHIMA Certified Coding Specialist (CCS). Project Management Professional (PMP).

Minimum Qualifications Education: Required Bachelor's degree or equivalent experience

Experience: 8-10+ years of progressively responsible healthcare revenue cycle experience, with a strong
focus on professional billing required. Direct management experience. Experience within a multi-specialty physician organization preferred.

Office/Site Location

Westwood

Regular, Temporary, Per Diem

Regular

Remote Eligibility

Part Remote/Hybrid

Pay Range

$99153.60-$158631.20 Annual