Revenue Integrity Manager

JOB SUMMARY 

Oversees professional staff responsible for managing, coordinating, and implementing Charge Description Master (“CDM”) and charge capture initiatives and processes to ensure revenue management and revenue protection. Serving in a senior leadership capacity, has direct interaction and interface with internal and external executive level staff. Facilitates CDM and charge capture education; ensures adherence to government/non-government regulatory directives; ensures appropriate levels of control are established to satisfy audit/review requirements; and facilitates revenue management communications and information flow. Oversees maintenance of accurate and timely patient accounting system(s) changes/updates to sustain data integrity and to facilitate claims processing; ensures quality reviews occur to identify and minimize system errors. Plans revenue management strategies as identified in data/report analyses to ensure consistency/standardization, to identify improvement opportunities, and to facilitate appropriate knowledge transfer. Plans, prepares, and administers annual budget; develops and maintains budgetary controls; balances department needs with Conifer annual budget goals. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Serves as a resource and in a consultative role to various levels of customers; works closely and collaboratively with other internal departments.
• Manages a professional team to evaluate, review, plan, implement, and report various revenue management strategies to ensure CDM integrity; to identify charge capture improvement opportunities; resolve billing edits and to facilitate appropriate education.
• Evaluates and maintains workflow processes to ensure efficiencies; works with all personnel involved in the revenue cycle to optimize CDM interfaces, billing edit resolution and charge capture processes.
• Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact and to ensure optimal revenue management; continually reviews and monitors billing and coding changes affecting CDM and charge capture processes to ensure accurate claims production, appropriate distribution of information, and to identify target areas for education.
• Provides incident management and problem resolution; views incidents and problems from a systemic perspective to determine enterprise-wide solutions; oversees implementation of recommendations and monitors results to prevent recurrence; investigates complex issues as required.
• Manages/oversees special projects and special studies as required for new clients, system conversions, new facilities/acquisitions, new departments, new service lines, changes in regulations, legal reviews, or other projects including, but not limited to:
  • Oversees pricing initiatives such as strategic pricing, across-the-board increases, tiered pricing, pricing transparency; conducts interim pricing reviews and performs financial analyses for strategic initiatives.
  • Manages implementation of CDM and/or charge capture corrective measures and monitoring tools to ensure sustainability of changes; reviews and monitors statistics and key performance indicators to identify improvement opportunities and ensure compliance with regulatory/non-regulatory directives.

FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense):          

• This position may be required to monitor and explain expense variances to budget on a regular basis

SUPERVISORY RESPONSIBILITIES 

This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

• No. Direct Reports (incl. titles)       Charge Review Specialist I-II, Revenue Integrity Analyst I-III,   Charge Audit Specialist

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Strong interpersonal communication and presentation skills, effectively presenting information to executives, management, facility groups, and/or individuals
• Ability to present ideas effectively in formal and informal situations; conveys thoughts clearly and concisely
• Ability to respond in a