ROLE DESCRIPTION
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TITLE: Manager, Revenue Integrity
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JOB CODE: 3173
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EXEMPT: X
NON-EXEMPT:
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DATE: 05/23
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REVISED:
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Minimum Qualifications:
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Current licensure as a registered nurse in the state of NJ.
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Bachelor's degree in Nursing or related field (can be in pursuit of degree).
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3-5 years of experience in a leadership role.
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2-3 years of experience working with CPT, HCPCS and UB Revenue Codes.
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POSITION SUMMARY
The Manager of Revenue Integrity will provide daily oversight and leadership to the Revenue Integrity team, which includes all payer audits, the Charge Description Master (CDM), charge capture processes, clinical denial appeals, OPPS Medicare claim edits and development of the Billing Determination Forms for clinical research studies. This role will include hands-on work in the review of claims held due to coding or charge edits, review of clinical documentation, the identification of corrections needed to get a claim billed and paid correctly, assistance with clinical appeals, and backing up all areas of responsibilities.
This position will collaborate regularly with the Patient Accounting team related to clinical questions on claims with the Finance team related to charge volume questions and with various clinical leaders and staff related to the correct documentation needed to support charges and/or Medicare coverage determination rules. The position requires a high level of problem-solving skill, the ability to work independently, the organizational skills to manage multiple things at once, and the ability to effectively manage a group of highly experienced employees with diverse responsibilities. Strong computer and research skills are essential.
QUALIFICATIONS
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EDUCATION (Required): Graduate of an accredited school of nursing as a registered nurse. Bachelor' degree in nursing or related field (can be in pursuit of the degree).
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LICENSE/CERTIFICATION: Current NJ license as a registered nurse is required. Certification in hospital outpatient coding (COC) is preferred.
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EXPERIENCE: 3-5 years of experience in a leadership role is required, ideally in revenue integrity functions. 2-3 years of experience working with CPT, HCPCS and UB codes is required. Experience working with CDM maintenance, appeal work and billing and clinical documentation systems is strongly preferred. Knowledge of the inter-relation between charging, coding and billing is required. The ability to communicate effectively with both clinical and non-clinical staff and leaders is required.
PERFORMANCE EXPECTATIONS
Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position.
WORK ENVIRONMENT
This position requires desk/computer work for a majority of the time. Essential functions of this position are listed on the Assessment and Evaluation Tool.
REPORTING RELATIONSHIP
This position will report to the Director of Revenue Integrity & Utilization Management. It directly supervises the PFS Medical Audit Supervisor, the Charge Description Master Supervisor, a Revenue Integrity Nurse Auditor and a Clinical Denial Appeal Nurse, as well as having indirect supervision of the Medical Audit Assistant.
The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
AtlantiCare is an equal opportunity employer that takes affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disability.
