Manager Revenue Integrity (Remote)

Trinity Health•Livonia, MI

1d•$42 - $63•Remote

About The Position

The Manager Revenue Integrity provides leadership and day-to-day operational management for local hospital revenue integrity functions. The role works with key stakeholders to prevent revenue leakage and maximize regional revenue, overseeing the Charge Description Master (CDM), pre-bill edits, root-cause analysis, denials coordination with Patient Business Service (PBS), denial prevention, audits, and education and training for multidisciplinary hospital teams. The manager also oversees revenue optimization opportunities, potentially including charge control processes, and improves staff and revenue performance through process redesign, policies and procedures, communications, continuing education, professional development, empowerment, and feedback. The position works with Revenue Integrity and Payer Strategies leadership to interpret payer contracts and apply contract terms and regulatory updates. It coordinates denial resolution and prevention, collaborates on corrective actions and process or system improvements, and provides education based on audit findings, regulatory and coding updates, and managed-care billing requirements. The manager schedules, hires, develops, evaluates, coaches, and supports staff; manages resources, projects, and collaborative relationships; and analyzes and communicates data, policies, procedures, studies, and key performance indicators. The role maintains knowledge of applicable laws, regulations, and organizational compliance requirements. This is a remote, full-time, day-shift position. Trinity Health describes itself as a mission-driven health organization committed to improving community health and care, guided by reverence, commitment to those who are poor, justice, stewardship, and integrity.

Requirements

Bachelor’s degree in finance, business administration, or a related field, or an equivalent combination of education and progressive revenue-cycle experience.
Five to seven years of progressively responsible revenue-cycle operations experience, including revenue integrity, or equivalent experience and education.
At least three years of management experience in a multifacility integrated healthcare delivery system, or revenue-cycle or revenue-integrity consulting experience.
Knowledge and experience in revenue integrity in an acute-care practice.
Strong understanding of appeals, denial management, medical necessity, and coding audits.
Ability to read medical charts and dictation and correlate services performed with charges on claim forms, including UB and/or 1550 forms.
Ability to organize, plan, and manage staff in revenue integrity and optimization activities for a large healthcare acute and professional billing organization.
Knowledge of laws and payer contracts governing hospital and/or physician-service billing.
Ability to work effectively with physicians, clinicians, office managers, administrators, third-party payers, governmental agencies, and colleagues.
Ability to interpret complex issues and clinical processes and recommend improvements.
Experience collecting and analyzing data and preparing written reports and proposals that incorporate findings.
Strong knowledge of DRG, APC, and OPPS reimbursement structures; pre-bill edits including OCE and CCI edits; and DNFB.
Ability to thrive in a fast-paced, multi-customer environment with competing needs and changing workload and priorities; varied or extended hours may be warranted.

Nice To Haves

RHIA, RHIT, CCS, CPC/COC, or other coding credentials preferred.
CDC (Healthcare Compliance Certification) preferred.
Experience maintaining or overseeing a Charge Description Master (CDM) preferred.

Responsibilities

Provide leadership and day-to-day operational management for hospital revenue integrity functions.
Motivate staff and work with stakeholders to prevent revenue leakage and maximize regional revenue.
Manage the Charge Description Master (CDM), pre-bill edits, denial coordination, denial prevention, audits, and staff education and training.
Manage revenue optimization opportunities, including charge control processes where applicable.
Work with Revenue Integrity and Payer Strategies leadership to support understanding of payer contracts, application of contract terms, and alignment with processes.
Monitor Medicare, Medicaid, and other payer websites and communications for changes affecting charging, coding, and billing; manage updates to support compliance and revenue optimization.
Coordinate denials received from the PBS center, ensure timely resolution and root-cause identification, and participate in multidisciplinary denial teams.
Conduct or manage root-cause analysis of denials and pre-bill edits and collaborate with teams to implement process or system improvements.
Prepare and conduct education related to audit findings, regulatory requirements and changes, coding updates, and managed-care billing requirements.
Develop colleague work schedules and manage team projects to provide cost-effective staffing and meet customer and quality requirements.
Elicit feedback from interdisciplinary teams, including medical staff, and coordinate problem resolution and corrective action for long-term solutions.
Assess departmental development needs and promote colleagues’ decision-making, communication, interpersonal, and professional skills through orientation and continuing education.
Hire employees, allocate resources, monitor performance, conduct appraisals, provide ongoing feedback, and manage disciplinary processes when needed.
Mentor and coach colleagues and provide counseling or conflict resolution regarding performance issues.
Analyze and present data; develop and communicate policies, procedures, and business documentation; conduct studies and prepare management reports and departmental key performance indicators.
Maintain working knowledge of applicable laws, regulations, and organizational integrity, compliance, and conduct requirements.