Revenue Integrity Administrator

Cheyenne Regional Medical Center•Cheyenne, WY

23d

About The Position

As the lead of the Revenue Integrity Division, the Revenue Integrity Administrator defines and carries out the strategy for maximizing gross and net revenue captured across the health system. The Administrator serves as the chief liaison between Revenue Cycle Administrator, Revenue Integrity Medical Director, and clinical departments. This position will also ensure the availability and interpretation of reporting and analytics necessary for the clinical and Revenue Cycle departments to drive financial improvement. This position oversees the following functions: hospital/facility coding, Clinical Documentation Improvement, revenue reconciliation, Revenue Guardian, payment validation, and avoidable write-off prevention, and reporting and analytics.

Requirements

Bachelor's Degree or higher in Business Administration, Health Care Administration, Clinical Administration, Finance, and/or related field
Eight (8) or more years of hospital Revenue Cycle, Revenue Integrity, and/or reimbursement experience
Seven (7) or more years of management experience, with an emphasis on project management
Ability to apply appropriate management and leadership techniques and to manage multiple staff members in an operational setting.
Advanced level of communication (verbal and written), interpersonal skills, problem solving, and organizational skills to maintain a high level of production and accuracy in an extremely task driven environment.
Experience using Excel, PowerPoint, and Word.
Excellent ability to understand and interpret statistical reports and perform quantitative analysis.
Advanced skills in critical thinking and problem solving in a variety of settings and translation of data into actionable steps.
Knowledge of insurance claim processing and third-party reimbursement.
Knowledge of state and federal regulations as they pertain to billing processes and procedures.
Knowledge of various types of provider reimbursement methodologies including per diems, inpatient Diagnosis-Related Groups (DRG)/All Patient Refined Diagnosis Related Groups (APRDRG) case rates, percent of charges, and outpatient surgery case rate methodologies
Knowledge of Revenue Cycle processes, medical billing and coding processes, detailed accounting principles, quantitative decision making, and process analysis
Ability to work independently, delegate responsibility, and take initiative across multiple workstreams
Time management and project management skills

Nice To Haves

Master's Degree or higher
Coding Certification to include, RHIA, RHGIT, CPC, CIC, CCA
Healthcare Financial Management Association certification

Responsibilities

Provides strategic leadership and oversight for organization-wide Revenue Integrity and charge capture functions, ensuring alignment with organizational goals and regulatory standards.
Partners with clinical departments to implement and sustain continuous performance improvement efforts that ensure accurate and compliant charge submission. Leads and executes transformational change by driving innovative, high-impact operational strategies to contribute to Cheyenne Regional’s strategic goals.
Leads the annual price adjustment process through pricing models and vendor contract management variance reporting to support data-driven adjustments.
Directs the management of Revenue Guardian, charge capture, reconciliation, and charge interfaces to ensure accurate charges across the healthcare organization.
Collaborates with billing departments to establish and maintain charge capture audit processes, to identify coding discrepancies and mitigate revenue leakage.
Partners with the Revenue Leadership Team to develop and execute advanced monitoring tools to evaluate the performance and impact of revenue cycle initiatives. Focuses on key metrics such as Accounts Receivable (AR) Days, timeliness of charge capture, Discharged Not Final Bill (DNFB), etc. while driving automation and process optimization to enhance revenue integrity and operational efficiency.
Manages and oversees development of policies, processes and workflows for hospital and professional coding, reviewing coding, medical necessity and level of care denials to ensure organizational best practices.
Collaborates with the Compliance department to ensure billing practice meets requirements across the health system.
Oversees and manages the division’s budget and financial targets, ensuring fiscal responsibility and alignment with strategic objectives.
Analyzes patient estimates and provides actionable insights to assist patient experience.
Reviews, analyzes and monitors organizational dashboards to identify trends, risks, and opportunities for improvement.
Collaborates with the Revenue Cycle Administrator and Medical Director of Revenue Integrity to meet organizational goals and metrics relative to charging and coding of accounts.
Participates in the Billing Grievance Committee to assist in monitoring and facilitating policies and regulatory compliance while meeting patient expectations.
Participates, implements, and maintains Lean Methodology within the Revenue Integrity Division.
Fosters cross-functional collaboration with clinical, financial, and operational departments to ensure optimal financial performance while maintaining high standards of accuracy, compliance, and efficiency.
Collaborates with the Medical Director of Revenue Integrity to engage medical staff for denial prevention and documentation improvement initiatives.