Manager - Professional Revenue Integrity

View full description

Requirements:

• Seven (7) years of cumulative leadership experience.
• With at least three (3) years management or leadership experience in revenue cycle, clinical divisions, or otherwise related to charge capture, coding, or billing professional claims.
• Strong analytical skills to identify trends and opportunities in revenue data, with the ability to present findings to diverse audiences.
• Skilled in fostering a collaborative, organized, and efficient work environment, where team members can manage multiple requests, adapt to changing demands, and perform well under pressure.
• Knowledge of healthcare regulations, including CMS guidelines, Medicare/Medicaid rules, and payer-specific requirements.
• Experience with Epic EMR.
• Proficiency in SAP Business Objects (SAP BO) or similar reporting and analytics tools for business intelligence (BI) reports.
• Advanced skills in Excel and PowerPoint.
• CCS - Certified Coding Specialist preferred . or
• CPC and/or CCSP - Certified Professional Coder preferred .

Responsibilities:

• Serve as a key point of contact for senior leadership regarding the scope and work of the Revenue Integrity Program Advisors.
• Prepare and present reports on revenue integrity efforts, outcomes, and opportunities for improvement.
• Lead, mentor, and manage a team of Revenue Integrity Program Advisors, providing guidance, training, and performance management.
• Keep the team up to date on changes in healthcare regulations, coding updates, and industry best practices.
• Collaborate closely with clinical divisions to identify opportunities to enhance charge capture and optimize revenue. Proactively provide solutions to improve documentation and coding accuracy, ensuring clinical services are properly reflected in revenue.
• Act as a primary resource for clinical divisions, providing timely and clear responses to questions related to revenue processes, billing practices, and compliance. Address inquiries with a focus on transparency and regulatory adherence.
• Lead the intake and evaluation process for new services or service line proposals from clinical divisions, conducting research into financial impacts, compliance considerations, and resource requirements. Provide recommendations and strategic insights to clinical and operational leadership.
• Work with clinical divisions to understand their reporting needs and ensure that financial reports and revenue summaries are tailored to each division while finding opportunities for standardization. Use these reports to provide actionable insights and visibility into performance metrics.
• Regularly review and adjust the reporting package to reflect evolving needs or new service lines, ensuring it remains an effective tool for decision-making.
• Collaborate with clinical, billing, and coding teams to resolve discrepancies in charge capture and billing processes.
• Serve as a liaison between revenue cycle operations and clinical teams, streamlining communication and resolving discrepancies or questions related to charge capture, coding, and billing processes.
• Ensure that clinical departments receive timely updates on relevant changes and best practices to optimize efficiency and accuracy.
• Provide additional coverage to the Revenue Integrity Program Advisors as needed.