Mgr-Revenue Integrity

Position Summary:
This position oversees the health system revenue capture and collaborates with those responsible for revenue reconciliation, charge implementation and charge routing, revenue improvement initiatives, and the coordination of updates needed to accommodate industry, regulatory, and payer policies that impact charging and billing practices. This position is responsible to track system charging metrics and facilitate process improvements to enhance full, and where appropriate, automated charge capture and billing system structure, maintaining coding and billing compliance and accommodating the varied entity structures within the health system to optimize net revenue and reduce charge lag. This position manages the large-scale account corrections in tandem with Corporate Compliance and oversees necessary account corrections involving charge updates and reporting. This position manages staff and operational processes within the department, providing oversight and leadership. This position is responsible for ensuring reduction of denials and bad debt write offs and top decile performance of accounts receivable portfolios.

Qualifications:
EDUCATIONAL REQUIREMENTS
Bachelor's Degree in Business Healthcare, Finance/Accounting or Related Field or

CERTIFICATION & LICENSURE REQUIREMENTS
Certified Professional Coder (AAPC) CPC upon hire or Certified Professional Coder - Hospital CPC-H upon hire or Certified Professional Coder - Payer (AAPC) CPC-P upon hire or Registered Health Information Tech (AHIMA) RHIT upon hire or Registered Health Information Admin (AHIMA) RHIA upon hire or Certified Coding Associate (AHIMA) CCA upon hire or Certified Coding Specialist (AHIMA) CCS upon hire.

EXPERIENCE REQUIREMENTS
Three (3) years or greater progressive management experience.Experience working with charge master and charge capture oversight across varied entity structures. Experience in application of CMS regulations, AMA-CPT, HCPCS, modifier, UB04, 837P, revenue code, and General Ledger (G/L) structure.Proficient in standard Microsoft Office suite of applications.Strong communication and interpersonal skills to manage relationships and collaborate with all levels in the resolution of charge and revenue opportunities and issues.

ADDITIONAL REQUIREMENTS

• EPIC readiness classes, certification, or proficiency in designated platform(s)
• Membership in National Association of Healthcare Revenue Integrity (NAHRI)

SKILLS AND KNOWLEDGE
Must demonstrate tact and diplomacy in interpersonal interactions, in addition to maintaining composure in confrontational situations. Requires strong oral and written communication skills, analytical, problem resolution skills, and customer service skills. Ability to lead teams, develop and adhere to work plans, and manage resources to bring about the successful completion of specific projects, goals and initiatives. Ability to analyze financial and other data for effective decision-making. Maintains current knowledge of relevant regulatory requirements as they relate to industry and payer regulations, policies and procedures. Must have or attain & become proficient within 120 days in applicable EPIC system modules. Upon review, will determine which Carle Health leadership courses may be required.

Essential Functions:

• Oversees the staff within the Revenue Integrity team. Reviews and manages workflows and processes to reduce missed or delayed charges, clear edits in work queue's, oversees the completion of needed charge corrections, assesses charge and billing errors for system improvement, and identifies new revenue opportunities.
• In conjunction with VP Business Office Operations and Director of PFS, develops strategic oversight, planning, goal setting, and leadership within areas of responsibility to align to organizational goals and pillars. In conjunction with the Directors PFS, prepares annual operating budget for department. Monitors, verifies, and reconciles department expenditures. Oversees personnel actions for hire, promotions, transfers, discharges, and disciplinary measures. Assists with completion of staff performance evaluations, and all required education and training curriculum.
• Works with clinical, supply chain, pharmacy, finance, compliance, information technology, revenue cycle, administrative and other teams across the health system to leverage EPIC functionality as it relates to charge capture. Supports departments related to new revenue initiatives, serving as a subject matter expert in the development of charge capture strategies. Makes recommendations and oversees projects for net revenue realization and billing compliance optimization and monitoring.
• Assesses and identifies services or items that are reimbursable but are not being charged and facilitates implementation.
• In collaboration with other SMEs, reviews, assigns, and validates charge flow and Charge Description Master structure of revenue codes, linked detail coding, or alternate coding to insure proper billing.
• Ensures compliance with government, payor, and internal charge capture policies for facility and professional services across the health system in a manner that optimizes appropriate revenue generation. Collaboratively interprets and communicates healthcare payment policies and practices and devises strategies to assure maximum reimbursement and minimize revenue leakage.
• Identifies, audits, and reports trends such as charge lag, charge and claim issues, or charge errors that require resolution. Works with leadership and departments to develop specific, meaningful reports to same.
• Supports charge capture systems and processes for all points of revenue to optimize net revenue realization, and charge lag. Facilitates provision of training associated with timely and accurate capture of charges. Acts as a resource and mentor to others.
• Facilitates charge void or adjustment as approved through leadership regarding patient or charging concerns. Facilitates completion of account correction processes involving charge updates and reporting completion summary data back to applicable owning parties.
• Ensures effectiveness of the revenue integrity program, including overall consistency and integration of integrity activities throughout the enterprise. Serves as a resource for organizational and operational matters related to revenue integrity issues.
• Maintains ongoing expertise in facility and professional charge capture, EPIC systems charging structure, coding and regulatory nomenclature, and applicable industry trends.
• Performs required tasks associated with the Carle Experience.
• Creates, updates, and maintains all departmental policies and procedures. Maintains appropriate internal controls for department.
• Adheres to and enforces Carle Health Administrative and Departmental policies and procedures.