Program Manager-Revenue Integrity

Aston Carter•Redwood City, CA

21h•$40 - $47•Remote

About The Position

The Revenue Integrity Program Manager is the face of Revenue Cycle Operations for the clinical departments, Chiefs of Staff and the School of Medicine Directors of Finance & Administration (DFA's). The Revenue Integrity Program Manager is responsible for ensuring compliance with government, payer and internal charge capture policies for both Technical (Facility) and Professional Services in a manner that optimizes revenue generation. The Revenue Integrity Program Manager reviews and manages workflows and processes to reduce missed charges, clear edits in work queues, ensure timely charge capture, and identify new revenue opportunities. This position works with NThrive software to manage the Charge Description Master (CDM). This position is also responsible for managing the NThrive Charge Capture Audit results, conducting root cause analyses, and assisting with the reduction of denials. Conducts Prospective reviews of charge capture practices in the clinical departments and reports findings, provides education to staff responsible for charge capture, coordinates charge capture improvement tools in collaboration with Revenue Cycle IT teams, evaluates revenue impact, monitors ongoing compliance and expected versus actual revenue changes. Reports potential compliance issues for further analysis and follow-up to the Compliance Department. Facilitates clinical SME use of NThrive for submitting CDM requests with a focus on regulatory coding, compliance and adherence to SHC internal guidelines regarding CDM maintenance, standard naming conventions and pricing integrity. In collaboration with Compliance Department, provides education to clinical department staff regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliance use. Leads projects to improve revenue compliance, efficiencies in the charge capture process, and CDM charge structures. Performs basic financial analyses to report the impact of payment changes resulting from payer practices and CMS regulation changes. Reports financial impact of charge capture practice changes and corrections to current practices. Communicates findings fully with clinical departments and executive team. Reviews EPIC WQs, conducts research needed to resolve the account issues and identifies gross and/or net revenue benefit expected from all account corrections completed. Reviews NThrive CCA file daily to discover and identify system compliance issues and revenue opportunities, conducts root cause analyses to correct identified charge capture issues, and reports the gross and net revenue differential resulting from each discover and correction completed. Develops criteria for reporting revenue performance to a variety of audiences including Faculty, DFA’s, Division and Clinic Chiefs, the Director of Revenue Integrity and others as appropriate. Responsible for presenting reports to a variety of audiences. Such reports will be accompanied by a thorough understanding of content and reasonable explanations for variations from the budget.

Requirements

Program management
epic
revenue integrity
excel macros
charge description master
Academic Medical Center HB or Facility Revenue Integrity
Service Lines
Epic Workqueues (WQs)
Charge Capture opportunities
Charge Workflow
Reporting package
Slicer Dicer
CPC or COC certification (Coding background)
Vital Integrity
Cloudmed

Nice To Haves

CPC
COC
CRCR
HB billing
finance
cdm

Responsibilities

Ensuring compliance with government, payer and internal charge capture policies
Reviewing and managing workflows and processes to reduce missed charges
Clearing edits in work queues
Ensuring timely charge capture
Identifying new revenue opportunities
Managing the Charge Description Master (CDM) using NThrive software
Managing NThrive Charge Capture Audit results
Conducting root cause analyses
Assisting with the reduction of denials
Conducting Prospective reviews of charge capture practices in the clinical departments and reports findings
Providing education to staff responsible for charge capture
Coordinating charge capture improvement tools in collaboration with Revenue Cycle IT teams
Evaluating revenue impact
Monitoring ongoing compliance and expected versus actual revenue changes
Reporting potential compliance issues for further analysis and follow-up to the Compliance Department
Facilitating clinical SME use of NThrive for submitting CDM requests
Providing education to clinical department staff regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliance use
Leading projects to improve revenue compliance, efficiencies in the charge capture process, and CDM charge structures
Performing basic financial analyses to report the impact of payment changes resulting from payer practices and CMS regulation changes
Reporting financial impact of charge capture practice changes and corrections to current practices
Communicating findings fully with clinical departments and executive team
Reviewing EPIC WQs, conducts research needed to resolve the account issues and identifies gross and/or net revenue benefit expected from all account corrections completed
Reviewing NThrive CCA file daily to discover and identify system compliance issues and revenue opportunities, conducts root cause analyses to correct identified charge capture issues, and reports the gross and net revenue differential resulting from each discover and correction completed
Developing criteria for reporting revenue performance to a variety of audiences
Presenting reports to a variety of audiences