Revenue Integrity Manager

Practice Area healthcare/allied-other
Job Family Allied Other
Job Type Perm Salary
Location Metrowest Boston

MANAGER OF REVENUE INTEGRITY

Westwood, MA

 

 

POSITION SUMMARY:

The Manager of Revenue Integrity serves as the chief liaison between revenue cycle and clinical departments.  The Revenue Integrity Manager also ensures the availability and interpretation of reporting and analytics necessary for the clinical and revenue cycle departments to drive financial improvement.  The RI Manager oversees and acts as a resource to all Revenue Integrity staff.

 

 

KEY RESPONSIBILITIES:

• Lead the Revenue Integrity department in an efficient and compliant manner of the Revenue Cycle;

• Oversee monitoring and improvement efforts within the functional areas of Revenue Integrity, including:

  • CDM Management – Ensure the Charge Description Master is maintained, new codes are entered timely, and any pre-bill edits are worked timely;
  • Charge Capture – Ensure appropriate audit activities take place prior to and after billing to ensure accurate and optimal revenue capture, and seek to continually improve charging processes within departments;
  • Revenue Reconciliation – Provide oversight of Revenue Reconciliation completed by operational and clinical leads across Steward, including the use of appropriate tools to support revenue and charging reconciliation;
  • Denial Management & Avoidable Write-Off Prevention – Utilize data analytics to identify trends and work with functional areas for future prevention; and
  • Reporting & Analytics – Provide objective analysis through advanced reporting and interpretation of findings to support Revenue Integrity processes;

• Oversee all functions performed by the Revenue Integrity team, including analytics and reporting, communication with departments and external stakeholders, and ongoing strategy and development of the program;

• Work with team to develop meaningful metrics and key performance indicators departments to drive strategic analysis and decision-making;

• Lead targeted revenue improvement opportunities and assist with analyzing the financial impact as related to hospital clinical departments;

• Work proactively with leadership within Revenue Cycle and Finance to prioritize areas of focus and ensure appropriate ongoing performance;

• Assist in the development and maintenance of appropriate controls and security of processes that lead to accurate clinical, operational, and financial operations; and

• Coordinate the above functions across hospital entities to ensure that best practice performance is achieved across the organization to a uniform standard.

 

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

  • Bachelor's degree in Health Care Administration, Business, Accounting, Finance, or related field. Revenue Integrity department or related experience preferred.
  • Three (3) years of hospital revenue cycle or reimbursement experience, including 1-3 years' management experience. Revenue Integrity-related experience preferred.
  • Meditech experience preferred. MS Office required.

 

REQUIRED KNOWLEDGE & SKILLS:

• Excellent ability to understand and interpret statistical reports and perform quantitative analysis;

• Excellent understanding of multiple clinical disciplines and charging practices;

• Knowledge and understanding of insurance claim processing and third-party reimbursement;

• Knowledge of state and federal regulations as they pertain to billing processes and procedures;

• Knowledge of the principles of Information Systems in order to effectively analyze and make decisions;

• Knowledge of healthcare related financial and/or accounting practices;

• Skill in effective oral, written, and interpersonal communication;

• Skill in problem-solving in a variety of settings and translation of data into actionable steps;

• Skill in time management and project management;

• Ability to read, understand and interpret, analyze, and apply complex regulatory requirements;

• Ability to work efficiently under pressure;

• Ability to operate a computer and related applications;

• Ability to apply appropriate supervisory, management, and leadership techniques in an operational setting;

• Ability to work independently and take initiative;

• Ability to demonstrate a commitment to continuous learning and to operationalize that learning;

• Ability to deal effectively with constant changes and be a change agent;

• Ability to deal effectively with difficult people and/or difficult situations;

• Ability to willingly accept responsibility and/or delegate responsibility; and

• Ability to set priorities and use good judgment for self and staff.

 

 

Position ID: 38856