Manager- Revenue Integrity

Fairview Health Services • St. Paul, MN

1d • Remote

About The Position

Fairview is looking for a Manager- Revenue Integrity to join our team! The Manager of Revenue Integrity is responsible for the leadership, development, coordination, implementation, and oversight of one or more Revenue Integrity team functions. This role provides strategic leadership and operational oversight for Fairview's revenue integrity functions, ensuring compliant, accurate, and efficient charge capture across the system. This manager defines the governance framework, performance standards, and continuous improvement strategies that guide accurate, compliant, and timely charging activities while ensuring enterprise-wide consistency, accountability, and alignment with payer, regulatory, and financial requirements. This role works cross-functionally across the continuum of Revenue Cycle and revenue-generating departments and maintains knowledge of charging workflows within the EHR, including its various applications and software. The manager of Revenue Integrity monitors metrics reporting, collaborates with IT in maintaining system applications, and partners cross-functionally with clinical and revenue cycle operational departments to achieve optimal system performance.

Requirements

• Bachelor of Science in Business Administration, Health Care Administration or related area PLUS 2 years of experience in health care reimbursement, financial management or coding OR an approved equivalent combination of education and experience
• Thorough knowledge of functions assigned
• Thorough knowledge of computer systems used by assigned revenue cycle team
• Knowledge of applicable regulatory requirements
• Knowledge and understanding of hospital revenue cycle operations (registration, charge capture, health information management, claims, payment posting)
• Ability to present to small and large groups
• Consistent demonstration of excellent written and verbal communication skills
• Proficiency in Microsoft Office: Word, Excel, Power-Point, Visio, Teams, SharePoint and Outlook.
• Performance improvement, project management and/or lean skills
• 3 years Applicable leadership business-related experience
• One or more of the following: RHIA, RHIT, CHRI, CCS, CPC, CCS, CPC, CCS-P, RN, or
• Epic Resolute Certification(s) in one or more of the following Epic applications: Resolute Professional Billing, Resolute Hospital Billing, Claims or
• Ability to achieve within one year of employment

Nice To Haves

• Masters of Healthcare Admin in Business Administration, Health Care Administration, Nursing, Education or related area
• 5 years Experience in coding, clinical documentation improvement (CDI), revenue integrity, quality, or a directly related functional area of work
• One or more of the following: RHIA, RHIT, CHRI, CCS, CPC, CCS, CPC, CCS-P, RN, and
• Epic Resolute Certification(s) in one or more of the following Epic applications: Resolute Professional Billing, Resolute Hospital Billing, Claims

Responsibilities

• Maintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures, and standards. Provides oversight to ensure compliance with established laws, regulations, practices, and procedures.
• Responsible for providing the operational oversight for system-wide charge capture activities. Provides operational direction for Charge Capture integrity, aligning direction with customer expectations, financial expectations, environmental requirements, and organizational objectives. This includes: • The analysis of department charges • The identification and implementation of charge improvement strategies • Assisting departments with their charge capture activities, including the development of charge reconciliation processes where needed.
• Sets, oversees, and ensures daily operations, service support and outcomes are performed timely and accurately in accordance with regulatory and payer requirements. • Designs and helps maintain workflows to ensure efficient and effective processes, monitors and prioritizes work based on organizational needs and assignments, and appropriately assures timely, productive, and efficient use of resources. • Ensures work assignments are performed and supported to achieve departmental goals and outcomes • Ensure staff members are knowledgeable about revenue assurance needs and reimbursement issues identified through audits, reviews, and aggregate data analysis. • Ensures key productivity and quality standards for department processes are adhered to and managed appropriately • Develops and tracks key performance indicators (KPIs) to monitor revenue integrity trends, communicate outcomes to leadership, and drive continuous improvement and achieve industry-level benchmarks for the department and team. • Selects, hires, orients, and trains qualified employees to perform job responsibilities, mentors and evaluates staff
• Develops and implements a formalized system-wide charge capture education plan including execution strategy and routine updates as needed
• Leverages analytics, audits, and charge reconciliation data to identify missing, miscoded, or unbilled charges, as well as underutilized CDM items; collaborates with operational and financial leaders to implement corrective actions and prevent recurrence. • Tracks and assesses integrity risks, and ensures the revenue integrity program is responsive to those risks, activates additional financial controls as appropriate and follows through to resolution • Leads and/or actively participates in committees addressing and/or is responsible for revenue integrity root cause and resolution activities
• • Partners with clinical and operational departments to translate charge capture findings into process improvements, workflow changes, and system optimization to ensure accurate use of CPT/HCPCS codes, modifiers, and revenue codes. • Serves as the primary liaison between Revenue Integrity and operational leaders for charge capture, pricing, and reimbursement integrity initiatives. • Facilitates cross-functional meetings to review trends, identify systemic risks, and develop corrective or optimization programs. • Establishes escalation pathways and feedback loops to ensure charge capture and pricing issues are prioritized and resolved in collaboration with Finance, Clinical Operations, and IT • Provides routine performance reports regarding the nature, progress, and status of the revenue integrity program, any course correction being taken, and any recommended changes • Provides technical expertise, troubleshooting issues, and input on improvement projects and product selection • Identifies, evaluates, coordinates, and implements tactics to achieve organizational objectives, improve operational efficiencies, and increase positive cash flow
• Leads the enhancement of charge description master (CDM) activities and supports maintenance of integrated revenue cycle applications, reviewing and optimizing organizational CDM structures to ensure all services and supplies are reflected accurately and are consistent with current industry best practices. Include clearly stated service level agreements and accountability for updates by all stakeholders
• Fosters a culture of improvement, efficiency and innovative thinking
• Monitors, evaluates, and manages department Budget by RCM leadership to achieve budget
• Leads or participates in work with peers and other departments to create an excellent understanding of workflows and interdependencies, and to identify and implement strategies to improve revenue cycle performance • Works collaboratively with vendors to assure performance expectations are being met • Represent Revenue Cycle and Fairview Health Services at industry forums to network and identify process improvement opportunities • Serves as a resource on revenue cycle issues and regulatory expectations • Creates strong collaborative partnerships and influences others across teams, groups, and business boundaries to achieve real-world problem solving

Benefits

• Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more!

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees