Manager, Revenue Integrity

Job Description

Reporting to the Revenue Integrity Director, the Manager of Revenue Integrity works collaboratively with others to optimize workflows and related information systems to help ensure accurate, complete, timely documentation, charges and coding of services. The Manager of Revenue Integrity must maintain extensive knowledge of all aspects of the revenue cycle including the registration, documentation, coding, billing and collection processes as well as government and payer regulations for both professional and facility billing.

This position is responsible for the analysis and assessment of diverse data relating to the revenue cycle. This Manager provides essential quality reports and improvement recommendations to management for all clinical service lines and revenue cycle departments.

• Helps ensure adequate training and education occurs to both providers and hospital departmental staff regarding accurate charge capture and documentation requirements.
• Oversees Charge Reconciliation, CDM Management and Charge Capture processes and training materials.
• Oversees CDM maintenance and development, including correct coding and charging, updating of pricing, adding new service lines, inactivating unused CDM service lines within established organizational policy and procedures. Works directly with managers and other key staff of revenue producing departments to identify billable services, and establish the charge process.
• Develops, documents, and maintains effective charging policy, procedures and training materials (as needed), for the organization.
• Participates in research of billing and coding requirements when new procedures and/or supplies are introduced. If appropriate to bill for new services, ensures related systems are set up correctly, tested, and monitors initial charging of services for proper billing as well as following claims for initial reimbursement.
• Collaborates with clinical leaders and others to review and evaluate new technologies and formulary items and establishes related documentation, charge capture, and coding protocols.
• Liaises with key stakeholders including Finance Departments, Compliance, HIM, Coding, CDI, Clinical Departments, Information Technology, as well as others.
• Facilitates the dissemination of information regarding government and third‑party payer regulations and requirements to clinical departments, providers, management and staff, as applicable.
• Oversees communication of coding and billing updates published in third‑party payer newsletters/bulletins and provider manuals to all stakeholders as appropriate.
• Works collaboratively with Professional Coding, Facility Coding and Compliance (when indicated) with performing appropriate reviews, investigating trends and patterns, and providing education regarding documentation, charge capture, charge reconciliation, billing/coding guidelines and denials. Ensures reviews are conducted on an annual basis and/or as otherwise identified, in all areas treating patients to ensure all professional and facility billable charges are captured and coded completely and accurately, and documentation reflects same.
• Maintains knowledge of government and third‑party payer audits and participates in denials prevention activities.
• Maintains a revenue optimization database, communicates and coordinates resolution of opportunities. Presents and communicates findings, trends, mitigation efforts and recommendations to established committees and key stakeholders.
• Assists and makes recommendations for third‑party payer contract language related to clinical coding standards and requirements. Participates in internal and external contracted payer discussions and negotiations regarding clinical coding and charging standards when needed.
• Develops and monitors metrics to ensure functions of the Revenue Integrity team are performed efficiently as well as with a high degree of accuracy and customer service.
• Coordinates external reviews for focused assessments as well as information system software review (CDM, Supply, Medications).
• Demonstrates support for the mission, values and goals of the organization.