MANAGER REVENUE INTEGRITY

Premier Health•Dayton, OH

8h•Remote

About The Position

The revenue manager is responsible for the daily operations of the Reimbursement Charge Master staff. Daily operations include communication to facility leadership on revenue analysis related to posted charges of the day prior and special projects related to either revenue or reimbursement. Proper management of the charge entry and revenue flow is critical to the successful coding and billing of claims to third party payors in the revenue cycle. This includes incorporating mandatory CPT/HCPCS codes to specific charges and setting programming triggers in the billing system to update hospital claims relative to the primary insurance payor. The pricing of charges is the other key responsibility of the Revenue Manager associated with charge master and charge build. This includes maintaining the fee schedules which drive hospital pricing on to patient claims. There are seven (7) master files in EPIC which have been assigned to the charge master team under the revenue manager. These master files require the design, build, maintenance, quality assurance, testing and implementation for all charges and prices loaded into EPIC Hospital Billing. The revenue manager is designated by EPIC as the Revenue Integrity Lead on the vendor’s Integrated Good Maintenance organizational support chart. In addition to charge creation, the revenue manager is responsible for the scope and implementation of appropriate charging workflows for each hospital service line based upon clinical applications that provide data for use in charge entry to EPIC. Responsibilities include meetings with all levels of hospital and corporate leadership to represent the team, department or Director of Reimbursement on matters related to both gross revenue generation and net reimbursement from third party payors. Annual projects assigned under the revenue manager include the successful implementation of the annual rate increase across 440 hospital departments for Premier and the annual code changes published by both the American Medical Association (AMA) and Medicare (CMS). Both projects have hard target dates of completion of January 1 and are completed via file maintenance and testing in the EPIC master files noted previously. As the EPIC integrated solution is updated or upgraded the revenue manager will collaborate with Premier Health Information Technology (core team) to insure that both master files for charge creation and charging workflows for charge entry within EPIC continue to perform to pre-upgrade specifications. This includes direct collaboration with Information Technology by staffing a post in any implementation or upgrade command center. The manager will provide technical guidance to IT teams and charge master staff on the build, testing and final validations related to system changes related to revenue generation.

Requirements

Bachelor’s degree in finance or related field is required.
Minimum Level of Experience Required: 5 - 7 years of job related experience
Prior job title or occupational experience: Minimum of five to seven years in hospital finance and or healthcare reimbursement.
A strong understanding of healthcare reimbursement required
Knowledge of CPTs, APCs, DRGs, and HCPCS code is required
Current knowledge hospital billing practices is required.
Current knowledge of Medicare and Medicaid regulations is required.
Two years of project management experience required.
Experience in working with upper management, physicians, and information systems is required
EPIC fFile maintenance experience required
Report writing experience required
Understanding of Managed Care contracts and language

Nice To Haves

Master’s Degree is preferred.
Epic Hospital Billing or Epic Charge Master is preferred.
Coding certification in at least one of the following is also preferred: CPC, CPC-P, RHIA, RHIT, and/or certification in auditing and/or Healthcare compliance.
Designation of proficiency in Hospital Billing and Charge Master is preferred.
3-5 years of prior management experience preferred.

Responsibilities

Daily operations of the Reimbursement Charge Master staff.
Communication to facility leadership on revenue analysis related to posted charges of the day prior and special projects related to either revenue or reimbursement.
Incorporating mandatory CPT/HCPCS codes to specific charges and setting programming triggers in the billing system to update hospital claims relative to the primary insurance payor.
Maintaining the fee schedules which drive hospital pricing on to patient claims.
Design, build, maintenance, quality assurance, testing and implementation for all charges and prices loaded into EPIC Hospital Billing.
Scope and implementation of appropriate charging workflows for each hospital service line based upon clinical applications that provide data for use in charge entry to EPIC.
Meetings with all levels of hospital and corporate leadership to represent the team, department or Director of Reimbursement on matters related to both gross revenue generation and net reimbursement from third party payors.
Successful implementation of the annual rate increase across 440 hospital departments for Premier and the annual code changes published by both the American Medical Association (AMA) and Medicare (CMS).
Collaborate with Premier Health Information Technology (core team) to insure that both master files for charge creation and charging workflows for charge entry within EPIC continue to perform to pre-upgrade specifications.
Provide technical guidance to IT teams and charge master staff on the build, testing and final validations related to system changes related to revenue generation.