Revenue Integrity Manager

ROLE DESCRIPTION

 

TITLE:   Manager, Revenue Integrity
JOB CODE: 3173	EXEMPT:  X NON-EXEMPT:	DATE: 05/23	REVISED:
Minimum Qualifications:
Bachelor's degree in Business, Healthcare Administration or related field required. 3-5 years of experience in a leadership role. 2-3 years of experience working with charge capture and reconciliation processes, CPT, HCPCS and UB revenue codes.

 

POSITION SUMMARY
The Manager of Revenue Integrity will provide daily oversight and leadership to the Revenue Integrity team, to include management of department productivity, trending of key performance indicators, and facilitation of team meetings. This position will serve as an escalation point for the Revenue Integrity team members and will work to proactively resolve issues.

In addition, this position will work with Revenue Cycle leadership counterparts, as well as clinical leadership, on Charge Integrity initiatives and will be responsible for executive-level communication to ensure information is shared on a regular and consistent basis.   

This position requires strong critical thinking skills, the ability to work independently, the organizational skills to manage multiple things at once, and effective management of a group of highly experienced employees with diverse responsibilities. Strong computer and research skills are essential.

QUALIFICATIONS

• EDUCATION (Required): Bachelor's degree in Business, Healthcare Administration or related field required.
• LICENSE/CERTIFICATION: Registered Nurse (RN), Certified Coding Specialist (CCS), Certified Professional Coder (CPC) or Certified Revenue Cycle Representative (CRCR) is preferred.
• EXPERIENCE: 3-5 years of experience in a leadership role is required, ideally in revenue cycle management/revenue integrity functions. 2-3 years of experience working with CPT, HCPCS and UB codes is preferred. Experience working with CDM maintenance, appeal work and billing and clinical documentation systems is strongly preferred. Knowledge of the interrelationship between charging, coding and billing is required. The ability to communicate effectively with both clinical and non-clinical team members and leaders is required.

PERFORMANCE EXPECTATIONS
Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position.

Leadership

• Collaborative and proactive management in leading teams.
• Goal-oriented with a focus on overcoming barriers to achieve objectives.
• Ability to mentor and support direct reports on their professional growth and development.
• Leads team through changes by preparation, delivering key messages and navigating through unexpected situations.
• Provides timely and effective feedback on performance expectations and outcomes.

Operations Management

• Manages and oversees 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.
• Proactively works with Revenue Cycle team members to monitor and ensure billing edits are worked within established parameters.
• Establishes collaborative action plans across the revenue cycle when needed to reduce claims held due to billing edits.
• Works to identify and implement focused areas of improvement to ensure the efficient claim processing.
• Provides proactive action plans to accommodate for team schedule variances related to clinical appeals, CDM support and edit resolution.
• Collaborates 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.

Regulatory

• Maintains a working knowledge of revenue cycle process to provide insight into the implementation of regulatory standards that assist the health system in cash collection, while accurately complying with billing guidelines.
• Supports the monitoring of compliance with corporate, federal and state guidelines, to include review of commercial bulletins for HCPCS/CPT code changes and additions and billing unit rule changes.

Training

• Supports the development and presentation of year-end education of key stakeholders on regulatory changes that will affect revenue for the enterprise.
• Provides support for the clinical and operational departments in understanding, identifying and remediating key operational issues leading to revenue leakage.
• Contributes to and supports the overall education level by creating a plan to keep staff innovative when it comes to their job functions.

Staff Management

• Serves as the lead for the development and execution of onboarding, training and education programs for Utilization Management, Revenue Integrity, CDM and audit staff to ensure talent development and optimal performance.
• Promotes a team concept reflecting the mission, vision and philosophy of the health system.
• Builds, champions and sustains a diverse work environment and culture in alignment with the mission of the organization.

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 statements reflect 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.

 

ROLE DESCRIPTION

 

TITLE:   Manager, Revenue Integrity
JOB CODE: 3173	EXEMPT:  X NON-EXEMPT:	DATE: 05/23	REVISED:
Minimum Qualifications:
Current licensure as a registered nurse in the state of New Jersey. Bachelor's degree in Nursing or related field (can be in pursuit of degree). 3-5 years of experience in a leadership role. 2-3 years of experience working with CPT, HCPCS and UB revenue codes.

 

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 hands0on work in the review of claims held due to coding or charge edits, review of clinical documentation and the identification of corrections needed to get a claim billed and paid correctly, assistance with clinical appeals, and back-up in 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, organizational skills to manage multiple things at once, and ability to effectively manage a group of highly experienced employees with diverse responsibilities. Strong computer and research skills are essential.

QUALIFICATIONS

• EDUCATION (Required): Graduate of an accredited school of nursing as a registered nurse. Bachelor's degree in Nursing or related field (can be in pursuit of the degree).
• LICENSE/CERTIFICATION: Current NJ license as a registered nurse is required. Certification in hospital outpatient coding (COC) is preferred.
• 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 well as billing and clinical documentation systems is strongly preferred. Knowledge of the interrelation 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, 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.