Summary: The Manager of Revenue Integrity leads and provides operational and technical direction to the Revenue Integrity teams and Patient Financial Services (PFS). Responsibilities include: Oversight on activities related to Charge Capture, Denials and Revenue Reconciliation process including problem accounts and Work Queues. Develop financial models to support strategic analyses and decision making; Create documentation to support training and assist in troubleshooting system problems; Oversee the use of appropriate tools to identify revenue leakage, maximize reimbursement opportunities, accelerate cash flow opportunities, and ensure that all revenue is captured; Serve as a technical leader and has overall responsibility for providing in-depth expertise with implementation of new revenue related systems, system conversions, and system integration; Working in conjunction with finance and clinical departments, the Revenue Integrity Manager; Seeks to continually improve billing processes and ensure accurate and optimal revenue capture and utilization of standardized workflows; and participates in hiring and mentoring staff to support those functions. Develop best practices for reporting and other analytics to identify opportunities or problems, process improvements, and other system changes; Assist as needed in ongoing review and process audits including compliance with third party and Government payors, proper coding, billing and denials. Work closely with Compliance Office and provides expertise to leadership and analysts in developing on-going analytic tools including ad-hoc queries and reports for members of the Revenue Cycle and Finance teams.
High school diploma or equivalent required. Bachelor's degree in Health Care Administration, Business, Accounting, Finance or related field preferred.
Five years hospital revenue cycle or financial analysis experience required.
Three years' experience in leadership role preferred.
Ability to apply appropriate supervisory, management, and leadership techniques in an operational setting.
Excellent ability to understand and interpret statistical reports and perform quantitative analysis.
Knowledge of the principles of Information Systems in order to effectively analyze and make decisions. Ability to read, understand and interpret, analyze, and apply complex regulatory requirements.
Knowledge of healthcare related financial and/or accounting practice.
Skill in problem-solving in a variety of settings and translation of data into actionable steps.
Ability to deal effectively with constant changes and be a change agent.
Detailed knowledge of diversified insurance plans and reimbursement methodologies and claim processing.
Knowledge of state, federal and compliance regulations as they pertain to charging, coding, and billing processes and procedures.
Prior experience with Epic Systems Revenue Cycle Solutions preferred.