Revenue Integrity Manager
: Job Details :

Community Memorial Hospital is looking for a full-time Revenue Integrity Manager. Job Summary: Ensure compliance with all regulations, policies and procedures related to medical billing for facility charges and physician services. The Revenue Integrity Manager reviews systems and processes to identify potential compliance issues, works with appropriate departments to correct such issues, serves as the internal resource for billing-related questions, provides training related to appropriate billing, and works with various departments to help ensure billing compliance. Performs other related duties as assigned to achieve the goals and objectives of the department and the organization. Responsibilities and Duties: Act as a resource for documentation, coding, claim review process, and billing questions for all Health Systems by staying up to date with local, state, federal laws, regulations and guidelines, as well as monitoring payer bulletins, periodicals and websites to maintain revenue cycle knowledge. Perform coding quality audits (monthly or weekly) of medical records to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines, CPT guidelines and health systems policies and procedures. Completes capture of patient revenue in every area that generates charges, management in relation to charging mechanisms and triggers, ensuring clean handoffs between clinical departments, strategic pricing, denials management, billing management and clinical operations relations. Fosters partnering relationships with the Compliance, Business Office, Health Information Management department, and other third parties to ensure the accuracy of the Charge Description Master (CDM) and fee schedules. Oversees CDM maintenance and enhancement by analyzing departmental charges, identifying and implementing charge improvements, assisting individual departments with reconciling charge discrepancies, and determine the reimbursement impact of CPT revisions. Coordinates with Finance/ Business Office, Health Information Management and other coding professionals to ensure that the codes contained in the charge description master and professional fee schedule are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing. Review of monthly reports to provide educational feedback on areas of possible documentation improvement to staff and providers. Provides on-going education, communication and meets with each medical coder and biller to review the results of each audit and provides feedback to resolve issues found in the audit with re-training or other educational methods. Assists Compliance Officer in planning and execution of compliance reviews, audits and activities. Assesses changes in the regulatory environment; research, investigates and responds to issues related to documentation, coding and billing. Assists, coordinates and participates in the record/claims audit process, provides documentation and compliance education sessions to physicians and other staff. Assist the Compliance Officer with other aspects/projects/tasks/reviews of the compliance program to assure compliance with applicable state and federal and CMS regulations. Implement changes in workflows and ques with the goal of improving Absentee Shawnee Tribal Health System s compliance in all aspects of operations, effectiveness and efficiency in billing and coding processes. Revise, change, edit and monitor workflow with the goal of determining best practices to result in compliance and maximization of revenue. Performs Gap Analysis of all the Revenue Cycle departments and makes recommendations for process improvements and training. Designs, analyzes, and implements information and reporting systems to monitor, detect and correct variations in revenue cycle performance. Review reports to determine best practices and track performances of those practices and promote potential changes, as needed. Resolves escalated issues that arise from operations and require coordination with other departments. Participate in Business Development initiatives to ensure proper compliance. Follow changes and policies within the industry, preparing plans and goals to grow with the changes; follow company policy changes and projections that may impact Absentee Shawnee Tribal Health System s services and programs. Administer and uphold all of the Health System s policies and procedures; recommend changes and/or creation of policies and procedures to enhance compliance and revenue management. Communicate with Company s employees and potential Business Associates as needed. Assists strategic sessions with management and health board of director to promote cost effectiveness of practices and procedures. Job Requirements: Bachelor s degree related to health care or information systems, business or related field required. Experience in E-clinical works Healthcare system for 3 years. Must have a working knowledge of reimbursement regulations for Medicare, Medicaid and Managed Care. Ten (10) years of experience in management of clinical billing or healthcare experience required with extensive knowledge of ICD-10-CM and CPT coding principles and guidelines. Extensive knowledge of federal regulations and policies pertaining to documentation, coding, and billing Must know how to perform proper revenue and reimbursement capture. Must be highly analytical, detailed and independent. Proven communication, organizational, and leadership skills required. Other education and experience substituted for above requirements require approval by Senior Director. Job Type: Full-time Salary: $95,000.00 $110,000.00 per year Benefits: 401(k) Dental insurance Flexible spending account Health insurance Health savings account Life insurance Paid time off Referral program Retirement plan Vision insurance Schedule: Day shift Education: Bachelor s (Required) #J-18808-Ljbffr