Manager Revenue Integrity

The Revenue Integrity Manager is responsible for the oversight and management of the department's daily activities, ensuring departmental goals are achieved through the implementation of quality control, productivity measures, and auditing processes. This position provides leadership to team members and managers. This position serves as a key stakeholder in the organization's reimbursement and revenue activities, conducting analyses of revenue cycle data to support the financial objectives of the health system. The manager also interprets governmental regulations, leading the development and implementation of process enhancements to comply with these standards.

Essential Job Function:

- Sets departmental productivity and quality objectives, develops and manages the departmental audit system to ensure team member compliance with standards.
- Offers training and coaching to enhance leadership and team performance.
- The position also assists in creating departmental strategic planning.
- Serves as key revenue integrity contact addressing issues such as denials, underpayments, refunds, and reimbursement.
- Collaborates with a diverse internal and external audience including physicians, payers, service line leaders, and team members, to ensure organizational financial objectives are met and enhance revenue capture and reimbursement.
- Serves as key liaison with third party payers to resolve complex, escalated issues.
- Analyzes a diverse set of data related to revenue cycle performance to enhance reimbursement and revenue capture.
- Communicates data and insights to stakeholders to drive action and process improvements.
- Additionally, the position entails designing and developing data reporting systems for timely distribution of information.
- Monitors and interprets government regulations impacting revenue cycle operations, ensuring stakeholders are kept informed of any changes, and organizational compliance.
- Serves as a key leader for revenue cycle compliance changes.
- Additionally, monitors and informs stakeholders of changes and updates to managed care payer policies and ensures organizational readiness.
- Leads and participates in cross functional organizational committees to support organizational financial goals, reimbursement, and compliance/regulatory activities.
- This role oversees the operations of the revenue integrity enrollment, credentialing, and revenue cycle auditing functions.
- Serves as a subject matter expert related to enrollment, credentialing, and revenue cycle compliance impacting reimbursement by both governmental and managed care payers.
- Oversees the planning, direction, and control of clinical denial management and audit activities from government and managed care payers.
- Collaborates with both external and internal stakeholders to develop processes and systems that minimize denials and maximize reimbursement.
- Effectively communicates with a broad audience to address denial issues and implement process improvements.
- Oversight of the revenue integrity payment variance and refund function.
- Works in collaboration with managed care contracting to resolve complex issues and ensure the accuracy of payment expectations in the billing system.
- Partners with cross functional leaders to resolve issues impacting reimbursement.
- Serves as a a secret matter expert related to reimbursement, payment variance, and refunds and guides the resolution of complex issues.
- Designs and facilitates training for a diverse audience to support organizational financial objectives.
- Additionally, oversees the revenue integrity education program to include delivery and content design.

Education:

- Required: Bachelor's Degree
- Preferred: Master's Degree

Experience:

- Required: 6 years of experience in Revenue Cycle.

Licensure/Certification/Listing:

- Preferred: HFMA CHFP or FHFMACoding CCS, RHIA, RHITEPIC certification in Revenue Cycle Modules.