MANAGER, REVENUE INTEGRITY

Job Description

The Revenue Integrity Manager develops, maintains, and reports on the chargemaster ensuring data integrity between the chargemaster and individual department's pricing schedules. The critical responsibilities include maintaining Epic charge description master including updates, setting new charges, reviewing for compliance, and making recommendations for optimizing reimbursement as well as maintaining competitive pricing. such as collaborating with clinical and non-clinical leaders to ensure appropriate usage of charge codes, regulating chargemaster compliance to requirements from governing bodies and assisting revenue-generating departments with pricing, charge capture, coding, and billing questions. The Revenue Integrity Manager reports to the Hospital Revenue Cycle Director.

Responsibilities

Job Responsibility

• Responsible for managing, coordinating, and implementing charge master (CDM) initiatives and processes to ensure revenue management and protection.
• Provides guidance to departments regarding strategic pricing services.
• Evaluates departmental CDM requests to ensure that all additions, changes, and deletions are consistent with proper hospital charging.
• Analyzes and resolves specific billing edits/errors that require clinical expertise and that are delaying claims for processing and reimbursement.
• Serves as the principal point of contact for charging issues.
• Responsible for reducing Accounts Receivable on Unbilled Accounts by working charge related errors.
• Research and resolve a variety of issues relating to charge capture. Edit claims (DNB, Claim Edits, and Stop Bills) within scope of authority to meet and satisfy timely billing.
• Represents Chargemaster issues and concerns on the various Epic design/testing/upgrade teams and committees.
• Manages CDM Epic projects including documentation, file building, testing, validation, workflow decisions, and implementation.

Clinical Skills

• Supports clinical units in charge capture, coding accuracy and revenue management.
• Works closely with clinical departments to maintain and educate for optimum charge capture and compliant billing.
• Works with the revenue producing departments to ensure ongoing coordinated consistency of CDM, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.
• Monitors organization wide uniformity in the application of charge codes for similar products and procedures.

Compliance Skills

• Conducts annual reviews of the chargemaster to identify codes that have been deleted, added, or replaced and ensures required updates to code descriptions.
• Identifies services that are not being coded but are technically reimbursable and discusses these services and codes with the reporting manager to determine suitable action.
• Supports the corporate compliance program by verifying adherence to charge posting policies and procedures, ensuring compliance with all applicable regulatory guidelines.
• Provides oversight and response for governmental and third-party payor audits.
• Develop and maintain corporate policies related to charge capture.

Communication/Interpretation Skills

• Holds meetings to educate department managers and other staff on changes to existing charge codes, validation of inactive codes and the development of new codes.
• Audits chargemaster changes, maintains a detailed trail of these changes, and communicates any change to all applicable departments.
• Ensures that all Chargemaster changes are appropriately communicated to affected departments and modifications made in related ancillary systems.

Education and Leadership Skills

• Good communication and customer service skills, including the ability to progressively investigate, analyze and identify sources of problems, provide practical solutions, and negotiate resolutions.
• Ability to make independent business decisions, considering both the impact to customer satisfaction and overall financial impact for the department and organization.
• Foster teamwork within the Charge Master auditing team.
• Professional attitude and ability to relate well with executive management, physicians, other care providers, patients, and others in the hospital/Network community.

Qualifications

KNOWLEDGE AND SKILLS:

EDUCATION:Bachelor's Degree required.

YEARS OF EXPERIENCE: Minimum of 5 years' experience as an analyst, preferably in a healthcare environment, with emphasis on chargemaster, revenue capture, charge auditing, reporting and reimbursement.

REQUIRED SKILLS AND KNOWLEDGE: Analytical skills required to make decisions based on the facility and clinical situation at hand. Demonstrated knowledge and experience in performance improvement. Computer Literacy - use of multiple systems. Excellent communication, critical thinking, decision making skills, and problem-solving skills. Knowledge of Epic CDM Manager/HB Resolute and Professional Billing preferred.

LICENSES & CERTIFICATIONS:

Coding certification is a plus.