Hospital Billing - Revenue Integrity Manager Job at Memorial Healthcare System (Hollywood)

Job Description

The Manager of Revenue Integrity is responsible for overseeing the daily operations, performance, configuration, and development of assigned applications to ensure alignment with departmental goals and objectives. This role manages a team of Revenue Integrity Analysts who provide technical expertise to support charge capture processes, system functionality, and compliance requirements. The Manager also designs, implements, and tests controls to optimize revenue capture, enhance net revenue, and ensure regulatory compliance across people, processes, and technology.

Job Responsibility

Manages the planning of application development and deployment
educates and promotes adherence to the organization's software compliance standards within the team
Selects opportunities identified by team to implement and improve existing processes using information technology and ensures alignment with strategic initiatives of the organization
Designs and evaluates the tools and processes used to capture charges in each MHS department
Updates the design of tools to empower departmental staff to accurately post charges efficiently, without rework
Designs and implements controls to empower departmental leaders to ensure staff have captured charges accurately and timely
Ensures Epic charge-related work queues are timely and correctly cleared
Utilizes subject matter expert skills to assist MHS leaders with analyses of billing, coding, and documentation requirements for payer coverage and payment of services affecting their service lines and initiatives
Monitors and provides training, support and troubleshooting to both application teams and end-users to facilitate proper usage and continuous learning
Manages applications projects including workflow analysis, end-user validation, acceptance, go‑live, and maintenance using standard project management methodology
Sets project deadlines and deliverables for specific modules and analysis
Manages the debugging and enhancements processes including the design and upgrades to existing systems in order to ensure up‑to‑date and reliable functionality
Periodically tests samples of departmental charges to evaluate whether staff members are performing correctly, and controls are operating as designed
Works with RCM and departmental staff to provide as-needed retraining as well as regular periodic updates for all charge capture staff
Manages and monitors staffing activities including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives
Develops annual CDM CPT/HCPCS updates and implements as approved by the Director of Revenue Integrity
Oversees the maintenance of CDM-driven CPT/HCPCS coding requirements
Develops annual CDM Fee Schedule updates and implements as approved by the Director of Revenue Integrity
Updates Price Transparency Standard Charges file in accordance with regulatory requirements
Keeps current, timely reads, and analyzes Medicare, Medicaid, and other technical guidance to determine how they affect Memorial Healthcare System (MHS) capture
Develops, recommends, and implements plans to comply with regulatory updates as approved by the Director of Revenue Integrity and in collaboration with responsible MHS leaders
Strategic focus: based on regulatory and industry updates, MHS strategic initiatives, end-user feedback, and other information, identifies and achieves opportunities to improve charge capture efficiency and accuracy, eliminate missed charges, eliminate billing rework, and improve MHS net revenue

Requirements

Associates (Required)
Epic Charge Router Certification (EPIC CHG ROUTER) - EPIC Certification (EPIC)
Epic Resolute Billing Certification (EPIC BILLING) - EPIC Certification (EPIC)
Minimum of five (5) years' Epic charge master (preferred) and/or billing experience
Able to build charge records (EAP) and controls (charge router, charge handler, and revenue guardian)
Minimum of three (3) years’ experience of supervising/managing a team
Candidate must have or be pursuing a coding credential (AHIMA or AAPC) which must be obtained within a year of taking the position

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Hospital Billing - Revenue Integrity Manager

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