Manager Revenue Integrity

ChristianaCare•Wilmington, DE

1d•$92,726 - $148,387•Onsite

About The Position

Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values of Love and Excellence and are passionate about delivering health, not just health care. Come join us at ChristianaCare! ChristianaCare, with Hospitals in Wilmington and Newark, DE, as well as Elkton, MD, is one of the largest health care providers in the Mid-Atlantic Region. Named one of “America’s Best Hospitals” by U.S. News & World Report, we have an excess of 1,100 beds between our hospitals and are committed to providing the best patient care in the region. We are proud to that Christiana Hospital, Wilmington Hospital, our Ambulatory Services, and HomeHealth have all received ANCC Magnet Recognition®. PRIMARY FUNCTION: The Manager, Physician Revenue Integrity is responsible for operational management, stabilization, and optimization of Professional Billing (PB) locations as it relates to the professional fee schedule, Epic Charge Generation Tracker (CGT), payer billing rules/regulations, denial prevention, charge capture, and charge reconciliation for all billable professional services. Additionally, this role is responsible for defining efforts and focus areas to address denial root cause in collaboration with PB Revenue Cycle Managers. The Manager, Physician Revenue Integrity acts as the primary contact for providers, clinical, and administrative staff to answer coding questions related to evaluation and management services, office-based procedures, and bedside procedures and initiates research related to revenue enhancement and correct coding for Epic PB clinical charge capture.

Requirements

Bachelor’s degree in Healthcare Administration, Accounting, or Business. Relevant experience may be considered in lieu of a 4-year degree.
Certified Professional Coder certification (CPC) required.
Five years of work experience related to professional billing and coding with at least three years in a progressive management role.
Must have proven experience of coding and billing requirements based on third party publications and contractual language, including Blue Shield, Medicare, Medicaid, commercial insurers and HMOs/ PPOs and other governmental insurance plans.
Proficiency with Epic Professional Billing (PB), including Charge Router, Charge Review work queues, Charge Capture workflows, and Charge Generation Tracker (CGT) configuration principles preferred.
Ability to evaluate and adopt emerging technologies that support revenue integrity, denial prevention, and analytic insight.
Demonstrated experience leading change management efforts, including workflow redesign, training, and stakeholder/employee adoption of new processes or system enhancements.
Ability to interpret compliance requirements and apply them to operational workflows, documentation standards, and charging practices.
Ability to cultivate and contribute to a culture of accountability, collaboration, and continuous improvement.
Exceptional interpersonal skills, with the ability to communicate complex billing or regulatory concepts clearly to providers, executives, operational leaders, and frontline staff.
Strong problem-solving abilities with the capability to make sound decisions in a fast-paced, high-volume, and complex environment.
Strong working knowledge of regulatory requirements, payer requirements, billing and collection processes and functions, coding requirements (ICD-10, CPT, HCPCs, etc.), general revenue cycle management strategies, and industry best practices.
Strong Knowledge of CMS regulations governing Medicare and Medicaid billing and reimbursement.
Strong knowledge of medical record content and structure.
Strong knowledge of state and federal laws governing billing.
Strong knowledge of physician office procedures as related to billing.
Ability to read and explain financial reports.
Ability to effectively present information and respond to questions from various groups.
Thorough knowledge of metrics, analytics, and data synthesis in healthcare revenue integrity and revenue cycle management to identify trends, produce reliable forecasts and projections.
Ability to apply Human Resource policies and procedures for personnel actions.
Ability to research and analyze charge and chart documentation.
Strong written and verbal communication skills essential for explaining problems and recommending solutions.
Substantial knowledge of Microsoft Office products (Word, PowerPoint, and Excel) as well as the Internet, for issue-related searches; ability to develop reports and create presentations.

Nice To Haves

Epic Revenue Cycle and Revenue Integrity experience preferred.

Responsibilities

Develops, implements, and oversees effective and consistent operational policies, processes, tools, and educational materials within PB Revenue Integrity functional areas.
Ensures Revenue Integrity staff compliance with all established policies, processes, and quality assurance programs.
Collaborates with IT and respective teams to develop dashboards and potential automated monitoring for charge capture, claim edits, and payer rule changes.
Serves as the operational lead for Epic PB enhancements, ensuring effective change management, communication, testing, and adoption of new functionality across clinical and administrative teams.
Evaluates and optimizes Epic Charge Generation Tracker (CGT) configuration to support compliant charging, reduce denials, and support accurate pricing strategies.
Owns the tactical framework for denial prevention related to charge capture, coding (when applicable), and payer edits; collaborates with PB Revenue Cycle Managers to operationalize sustainable root-cause solutions.
Ensures continuous regulatory readiness by maintaining compliant charge capture workflows, partnering with Compliance as needed for routine internal audits, external audit response, and corrective action planning.
Develops team capability through ongoing coaching, structured training plans, and performance development planning.
Leads the establishment and implementation of Key Performance Indicators (KPIs) for PB revenue integrity functions; ensures the implementation of action plans where performance is not meeting expectations; reviews KPI expectations annually and adjusts appropriately.
Oversees code and payer coverage analysis for new services/products.
Manages daily activities of revenue integrity areas.
Audits unbilled work queues for root causes (pre-bill edits) and uncoded services.
Provide guidance to revenue integrity analysts.
Reviews detailed daily/weekly/monthly dashboard reports for each entity, including work queue volumes, denial trends and key performance indicators, and takes appropriate action to ensure department/organizational goals are being met.
Builds and maintains a close relationship with payer provider representatives to ensure proper claim processing.
Maintains comprehensive knowledge of regulatory requirements related to third party billing rules.
Responds to inquiries with regards to CMS policies, third party payer guidelines, and billing department protocols.
Reviews communications received from third party payers and shares information with impacted personnel.
Prepares and revises policies and procedures as warranted and conducts in-service/meetings with caregivers.
Safeguards the integrity of billed accounts by ensuring compliance with billing, documentation, and coding standards.
Attends, participates, and conducts departmental staff and management staff meetings.
Complies with the approved budget.
Adheres to established departmental safety rules and practices and reviews routinely with staff.
Performs other duties, as required.