Manager, Quality & Revenue Integrity

Ovation Healthcare • Crest, CA

1d • Remote

About The Position

The Manager of Quality Assurance & Revenue Integrity is responsible for leading initiatives that ensure the accuracy, compliance, and optimization of hospital revenue cycle processes while maintaining high standards of clinical documentation and regulatory compliance. This role partners internally and externally with clinical, coding, billing, compliance, and finance teams to reduce revenue leakage, ensure appropriate reimbursement, and uphold quality and regulatory standards. This role will monitor industry resources i.e., CMS, OIG, AMA etc. for audit trends, code changes and operationalize those topics in a proactive manner to Ovation services and alert leaders to potential concerns and trends.

Requirements

• Deep understanding of hospital revenue cycle processes to include CDM and reimbursement methodologies (DRG, APC, etc.)
• Strong knowledge of regulatory and compliance requirements (CMS, Medicare, Medicaid, commercial payers)
• Expert level with policy and procedure creation
• Advanced analytical and problem-solving skills
• Expert level in research for coding and payor guidelines
• Proficiency in healthcare IT systems (EHR, billing systems, auditing software)
• Able to multi-task across multiple EHRs and Encoders
• Proficiency in PowerPoint, Excel and Word
• Able to trend metrics with pivot table and percentages in Excel
• Ability to interpret complex data and translate into actionable insights
• Strong communication and leadership skills
• Able to coordinate, lead and/or participate on huddles, groups and teams on projects to completion
• Detail-oriented with a focus on accuracy and compliance
• 5–8+ years of experience in healthcare revenue cycle, coding, auditing, or compliance
• Strong experience and expert working knowledge with hospital billing (inpatient/outpatient), clinic, ancillary and other services areas and applicable code sets (ICD-10, CPT, PCS HCPCS, Modifiers), and payer regulations
• 3+ years in a leadership or managerial role preferred

Nice To Haves

• RHIA (Registered Health Information Administrator)
• RHIT (Registered Health Information Technician)
• CCS (Certified Coding Specialist)
• CPC (Certified Professional Coder)
• CHC (Certified in Healthcare Compliance)

Responsibilities

• Develop, implement, and maintain revenue integrity programs to ensure accurate charge capture, coding, billing, and reimbursement.
• Identify, analyze, and mitigate revenue leakage across inpatient, outpatient, and ancillary services.
• Conduct regular audits of charges, coding, billing edits, and reimbursement patterns.
• Collaborate with facility HIM & Compliance teams to ensure completeness and accuracy of medical records.
• Support accurate DRG/APC/ProFee assignment and appropriate reimbursement.
• Evaluate coding trends and provide education to coding staff, clinicians and other contacts.
• Ensure compliance with federal, state, and payer regulations (CMS, HIPAA, OIG, etc.).
• Establish and maintain internal audit programs for clinical documentation, coding accuracy, and billing compliance.
• Prepare documentation and support external audits and regulatory reviews.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed