Revenue Integrity Manager - Green Bay, WI

Back

Revenue Integrity Manager

#25-417

Green Bay, Wisconsin, United States

Apply

X Facebook Linked In Email Copy

Location

Hansen-006

Description

Revenue Integrity Manager

Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care.

Job Summary
The Revenue Integrity Manager will lead the development of the revenue integrity function and is responsible for the oversight and management of the revenue integrity team. This position is accountable for optimizing revenue by ensuring accurate, compliant, and efficient charge capture and billing practice. The Revenue Integrity Manager will improve the performance of revenue cycle processes including developing best practices, coordinating issue resolution, establishing proactive lost revenue prevention measures, and monitoring compliance.

The ideal candidate has a strong understanding of EPIC systems, coding standards, and billing regulations across both physician and facility revenue streams.

What you will do

• Utilize data analytics and process improvement techniques to identify potential revenue leakage and support accurate charge capture. Use EPIC reporting tools to extract and analyze charge data. Perform extensive data mining, develop reports, review trends, and recommend enhancements to resolve lost revenue.
• Manage a team of chart reviewers. Design and implement a chart review program to ensure completeness of records, appropriateness of billing, and compliance with regulatory and payer requirements.
• Identify coding and documentation discrepancies to provide recommendations. Monitor for positive or negative trends in coding, charge capture and/or editing processes. Analyze denial trends related to charge capture and billing. Collaborate with coding, billing, and clinical teams to identify root causes and implement corrective actions.
• Maintain documentation of audit findings, trends, and resolutions to support compliance and training efforts. Measure key performance indicators (KPIs). Prepare reports and present findings and recommendations to management.
• Oversee and maintain the CDM, identifying opportunities for missed revenue. Including an annual comparison of Prevea's CDM and supply/implant costs to payer contracts. Develop and maintain all retail pricing. Participate in service line pricing reviews.
• Research and stay current on CMS, federal and state regulations, payor guidelines, ensuring compliance and alignment with charge, coding and charge edits. Complete analysis of revenue impacts as a result of CMS payment changes.
• Performs full range of managerial responsibilities which may include but not be limited to interviewing, hiring, coaching and developing employees; planning, assigning and directing work. Encourage innovation, teamwork, fiscal responsibility, and high-quality work.

Education Qualifications

• Bachelor's Degree Business or Healthcare related; or Associate's degree with 3 years of related work experience in healthcare revenue integrity or revenue cycle. Required

Experience Qualifications

• 5-7 years Healthcare revenue integrity or revenue cycle experience Required
• 3-5 years Leadership experience Required
• 3-5 years Experience with EPIC clinic or hospital billing systems Preferred

Skills and Abilities

• Knowledge of Revenue Cycle, Coding, and Charge Capture. Strong understanding of charge capture workflows, CPT/HCPCS, ICD-10, modifiers, documentation requirements, and payer billing rules.
• Regulatory & Compliance Knowledge. In-depth knowledge of CMS, Medicare/Medicaid, NCCI edits, payer guidelines, pricing regulations, and the ability to apply regulatory updates to internal processes.
• Data Analysis & Reporting Skills. Proficiency using EPIC reporting tools and other analytics platforms to extract, analyze, and interpret charge data, denial trends, and financial impact models.
• Charge Description…