Manager, Revenue Integrity

Overview

Job Description - Manager, Revenue Integrity )

LifePoint Health Support Center

Description

Work collaboratively with the HSC and hospital field personnel in ensuring the appropriate pricing, charging, coding and billing of facility services performed. Responsible for assisting in the maintenance of an accurate and complete LPNT HSC Standard Chargemaster while ensuring compliance with governmental/regulatory billing requirements. Perform periodic CDM review and provide best practice education as a result of findings. Serve as LPNT HSC Revenue Integrity SME in daily charge capture operations.

Provide communication to LPNT HSC Senior Leadership and staff regarding revenue integrity optimization outcomes as it relates to charge accuracy and charge capture.

• Perform periodic CDM review and analysis
• Conduct daily charge capture audit and education in high performing areas (i.e., Observation, Surgery, ED, Injection and Infusions, etc)
• Develops and delivers charge capture education to hospital staff
• Actively participates in the development and implementation of performance improvement program for charge capture
• Maintains responsibility for ensuring integrity of the documents that support patient billing
• Reviews claim denials and rejections pertaining to billing, authorization, coding and documentation requirements
• Provides periodic updates to the CFO, CNO, BOD, Department Directors for appropriate action based on areas of highest risk associated with missing or inappropriate charge capture
• Provides detailed information from charge capture reviews when specific departments or areas are identified with under/over charging issues
• Serve as Revenue Integrity SME for charging and documentation
• Keep abreast of APC, CPT changes to ensure preparation for outpatient prospective reimbursement by identifying areas affected and working to ensure compliance
• Assist with oversight of Charge Master
• Maintains current knowledge of insurance plans and government programs in order to ensure compliance with current hospital policies and procedures and how these proposed changes in regulations will impact the institution and disseminates the information to hospital staff
• Maintains working knowledge of the flow of information for the billing process and the clinical documentation that provides support to the billing process
• Provides guidance to departments in reducing late charge report totals

• RHIA, RHIT, CPC, CPC-H or Associates degree in Health Information Technology
• Bachelors Degree preferred
• Minimum of 2 - 3 years Revenue Integrity/Charge Capture experience
• If the minimum education/experience is a combination of education and experience, the employee must acquire the AAPC CPC-H credential from the American Academy of Professional Coders (AAPC) within one year of hire or transfer
• At least 2 years’ experience in audit and/or performance improvement
• Knowledge of electronic documentation systems

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requires prolonged sitting and some bending, stooping, and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment. Requires normal range of hearing and eyesight to record, prepare, and communicate appropriate reports. Requires lifting papers or boxes up to 50 pounds occasionally. Work is performed in an office environment and involves frequent contact with staff and the public.

LifePoint Health, Inc. is an Equal Opportunity Employer

EOE Minorities/Females/Protected Veterans/Disabled

LifePoint Health is committed to being a place where employees want to work and takes seriously our responsibility to comply with all regulatory and legal guidelines throughout the recruitment and hiring process. The recruiting process with LifePoint Health will always include emails to job candidates from an address ending in “”, as well as at least one phone interview and/or in-person interview prior to hiring.

This job description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this job description. The individual(s) may be called upon and required to follow or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives.