Manager Revenue Integrity

The Revenue Integrity Manager is responsible for the oversight and management of the department's daily activities, ensuring departmental goals are achieved through the implementation of quality control, productivity measures, and auditing processes. This position provides leadership to team members and managers. This position serves as a key stakeholder in the organization's reimbursement and revenue activities, conducting analyses of revenue cycle data to support the financial objectives of the health system. The manager also interprets governmental regulations, leading the development and implementation of process enhancements to comply with these standards.

Responsibilities

Oversees daily departmental activities and ensures departmental goals are achieved through quality control, productivity measures, and auditing processes; Provides leadership to team members and managers; Analyzes revenue cycle data to support the financial objectives of the health system; Interprets governmental regulations and leads development and implementation of process enhancements to comply with standards; Sets departmental productivity and quality objectives and manages the departmental audit system; Offers training and coaching to enhance leadership and team performance; Assists in creating departmental strategic planning; Serves as key revenue integrity contact addressing denials, underpayments, refunds, and reimbursement; Collaborates with physicians, payers, service line leaders, and team members to meet financial objectives and enhance revenue capture and reimbursement; Serves as key liaison with third party payers to resolve complex, escalated issues; Analyzes revenue cycle performance data; Communicates data and insights to stakeholders to drive action and process improvements; Designs and develops data reporting systems for timely distribution of information; Monitors and interprets government regulations impacting revenue cycle operations and keeps stakeholders informed of changes; Serves as key leader for revenue cycle compliance changes; Monitors and informs stakeholders of changes to managed care payer policies and ensures organizational readiness; Leads and participates in cross functional committees supporting financial goals, reimbursement, and compliance/regulatory activities; Oversees revenue integrity enrollment, credentialing, and revenue cycle auditing functions; Serves as subject matter expert on enrollment, credentialing, and revenue cycle compliance; Oversees planning, direction, and control of clinical denial management and audit activities from government and managed care payers; Develops processes and systems that minimize denials and maximize reimbursement; Oversees the revenue integrity payment variance and refund function; Works with managed care contracting to resolve complex issues and ensure accuracy of payment expectations in the billing system; Partners with cross functional leaders to resolve reimbursement issues; Serves as subject matter expert on reimbursement, payment variance, and refunds; Designs and facilitates training for a diverse audience; Oversees the revenue integrity education program, including delivery and content design

Requirements

Bachelor's Degree (required); 6 years of experience in Revenue Cycle (required); HFMA CHFP or FHFMA, Coding CCS, RHIA, RHIT, or EPIC certification in Revenue Cycle Modules (preferred)

Nice to have

Master's Degree (preferred); HFMA CHFP or FHFMA (preferred); Coding CCS (preferred); RHIA (preferred); RHIT (preferred); EPIC certification in Revenue Cycle Modules (preferred)