The Revenue Integrity Manager is responsible for the ongoing identification and implementation of revenue integrity solutions. The Revenue Integrity Manager performs or oversees continual coding audits, claims denial management and serves as an internal ICD -10 Certified Trainer. This position will partner with various clinical and non-clinical departments to improve charge capture, business office efficiencies and overall coding data integrity in compliance with all federal, state and local legal/regulatory requirements. This position requires strong communication, analytical, organizational, implementation and people management skills. Knowledge of revenue cycle operation is required. Denial recovery experience in a hospital setting is preferred.
Billing and Coding Audits:
1. Work with Revenue Cycle team members and executive management to develop and reinforce process improvement frameworks in the areas of:
a. Charge capture integration
b. Charge reconciliation
c. Revenue Cycle training
d. Company-wide revenue responsibility
2. Proactively seeks opportunities to identify revenue cycle inefficiencies, research/analyze data, and create solution alternatives.
3. Monitor and audit the performance of revenue cycle activities. Works with management to develop appropriate audit and monitoring processes and metrics.
4. Coordinate revenue cycle improvement activities between affected departments.
5. Analyzes and identifies trends in revenue cycle operations. Uses this data to develop and implement process redesign solutions.
6. Accountable for the development of project documentation for senior executives to facilitate sharing of audit outcomes and best practices.
7. Ensures strategic direction of projects is in line with organizational mission, vision and values.
8. Establishes procedures regarding implementation of best practices.
9. Establishes effective professional business relationships with all levels of management.
10. Functions as a contributing and effective member of the Revenue Cycle Management team.
11. Other special projects and duties as assigned.
ICD-10 Certified Trainer:
1. Serves as the subject matter expert for ICD-10-PCS Coding.
2. Responsible for creation of training materials specific to procedural coding.
3. Responsible for staff training and continuity of data entry processes.
1. Responsible for processing, workflow and management of clinical denials. Manages the company-wide claim recovery process of unpaid/denied claims.
2. Coordinates payer denial and audit activities to ensure timely response for the processing of all payer denials, audit requests and appeals.
3. Develops and maintains the tracking tool that stores/communicates all denial and review activity.
4. Collects and analyzes data and develops report metrics and trends of claims denial. Recommends process improvements to avoid future denials.
5. Oversees the coordination of denial and review activities and materials for committee meetings.
6. Motivates staff to exceed performance goals, develop and foster accountability, prioritize workflow and ensure deliverables are completed on time.
1. Performs annual evaluations and competency reviews for direct reports.
2. Interviews candidates for positions within department; makes hiring recommendations
3. Oversees ongoing staff training and development.
Demonstrated knowledge of revenue cycle business processes, including scheduling, registration, documentation, coding, charge entry, billing, collections and reimbursement.
Knowledge of basic business management and accounting principles related to revenue cycle processes.
Knowledge of computer software programs, spreadsheets and applications.
Knowledge of medical terminology, coding and office procedures.
Knowledge of third-party and insurance company operating procedures, regulations and billing requirements and government reimbursement programs.
Demonstrated knowledge of ICD-10 coding regulations.
Skill in establishing and maintaining effective working relationships with other employees, patients, organizations and the public. Training and development of staff.
Skill in departmental audit processes, fiscal management and denial management.
The job holder must demonstrate competencies applicable to the job position. Exempt classification.
Ability to process patients and public inquiries and respond with poise and efficiency.
Ability to recognize, evaluate, solve problems and correct errors.
Ability to conceptualize work flow, develop plans and implement appropriate actions.
Ability to maintain confidentiality of sensitive information.
Ability to foster and maintain a positive work environment and uphold the company’s values.
- Education: Bachelor Degree required.
- Licensure/Certification: Certified Professional Coder certification required. ICD-10 certification required. RHIA or RHIT preferred.
- Experience: Minimum of five years medical business office experience, including knowledge of billing/coding and related information systems, required. Prior supervisory/management experience preferred.