Revenue Integrity Program Manager (Remote

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

The Revenue Integrity Program Manager is a critical role responsible for optimizing hospital and professional revenue, identifying potential revenue leakage while ensuring compliance in charging and billing practices within the healthcare system. Serving as the primary liaison for Revenue Cycle, This position interfaces directly with clinical departments leaders, Clinical Department Chairs, and School of Medicine Directors of Finance & Administration (DFA).

Through a combination of data analytics, and process improvement techniques, this role will support the accurate capture of charges, identify meaningful opportunities to improve, and work closely with physician leadership and partnering with Compliance to provide education and training. This position will also provide ongoing communication through reports & regular presentations as well as handling intake of requests and potential improvement opportunities.

Prepares and leads the monthly Revenue Integrity and the School of Medicine DFA meetings for professional revenue cycle.

Stanford Health Care

• Charging Optimization:
  Conducts prospective and retrospective reviews/audits of charge capture practices in the clinical departments. Reports findings, provides education to both Providers and charge capture support staff. Coordinates charge capture improvement tools in collaboration with Revenue Cycle TDS IT teams. Reports potential compliance issues for further analysis and follow-up to the Compliance Department.

• CDM Optimization:
  Works to ensure a compliant and consistent system CDM. Works with existing tools to evaluate CDM requests with a focus on regulatory coding, compliance, and adherence to SHC internal guidelines regarding CDM maintenance, standard naming conventions and pricing integrity.

• Department
  
  Education:
  
  In collaboration with the Compliance Department, provides education to clinical department staff regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliance use.

• Project Management:
  Leads projects to improve revenue capture, increase efficiencies in the charge capture process, and reduce provider burden with the charging process.

• Financial Analysis:
  Performs basic financial analyses to report the impact of charge capture practice changes and corrections to current practices. Communicates findings fully with clinical departments and executive team.

• Issue Resolution:
  Through the combination of EPIC WQs, external edit platforms, and ongoing evaluation, identifies charging issues and works to identify solutions.

• Performance Review:
  Provides ongoing reporting of revenue performance to a variety of audiences including Chairs, Faculty, DFA’s, Division and Clinic Chiefs, Executive Director, Mid-Revenue Cycle, the Director of Revenue Integrity and others as appropriate. Responsible to present confidently to a wide range of individuals across the organization.

• Bachelor's degree in a work-related discipline/field from an accredited college or university (or equivalent combination of education/experience)

• Five (5) years of progressively responsible directly related work experience

• Proficient in hospital and professional revenue cycle operations.

• Expert in analyzing revenue data to identify trends and opportunities with the capacity to communicate findings effectively to varied audiences. Ability to analyze revenue data and identify trends and opportunities and the ability to present such data to a variety of audiences

• Strong Interpersonal skills facilitating seamless communication with clinical staff, and faculty. hat allow ease of communication with Clinical staff and faculty

• Solid understanding of coding conventions and current third-party payer rules and regulations Knowledge of coding conventions

• Current knowledge of third party payer rules and…