Revenue Integrity Manager

Tenet•Detroit, MI

About The Position

The Revenue Integrity Manager manages the revenue analysis function for the assigned hospital and ambulatory sites and reports to the Director Revenue Analysis. The role is responsible for preparing and completing eReserve, analyzing eReserve and items or trends that significantly affect net revenue, and reviewing and approving manual adjustments and refunds. The manager monitors and analyzes accounts receivable and disputes, assists with bad debt initiatives, and monitors and communicates non-reimbursable charges such as unsigned ABNs, denials, disputes, and bad debt. The position reviews proposed managed care contracts for implementation issues, assists with verifying that contract terms are loaded correctly into IMaCs, and checks that claims are properly adjudicated during and after managed care negotiations. It also monitors billing, accounts receivable, and reconciliation for hospital-specific contracts. The manager works with hospital departments, leadership, and related entities to address revenue cycle issues and facilitates revenue cycle meetings and follow-up. The role supports, directs, or monitors department head and chart audit meetings, compliance committees, charge master review and updates, pass-through invoice retrieval, complex in-house patient meetings, revenue cycle implementation initiatives, audit assistance, and engagement of legal resources for collection issues. Children’s Hospital of Michigan is an international leader in pediatric and adolescent medicine, with hospital, Troy, and ambulatory-site services. The employer describes a workplace focused on quality care, compassionate people, and diversity and inclusion.

Requirements

Bachelor’s degree in Business, Health Administration, or a related area, or an equivalent combination of education and/or experience.
Four or more years of experience in accounts receivable management and/or managed care contracting and analysis.
High analytical ability to compile revenue cycle data, interpret complex financial reports and activities, and present findings.
Ability to understand revenue cycle relationships, identify potential discrepancies, and resolve complex business operational issues.
Ability to evaluate processes and conduct cost and pricing studies.
Communication and interpersonal skills for obtaining and interpreting information from internal and external customers and stakeholders.
Ability to exercise discretion in deciding what and how to communicate.
Conflict resolution skills, diplomacy, tact, and listening skills.
Ability to read, interpret, and write technical materials.
Project management skills, including defining objectives, identifying stakeholders, planning steps, and coordinating human, technological, and fiscal resources.
Thorough understanding of mathematical logic for complex financial studies and drawing valid conclusions from data.
Strong technical knowledge of financial analysis, billing, and reimbursement.
Thorough understanding of financial services computer systems, accounts receivable and collection report formats, policies, and procedures.
Proficiency using a personal computer and spreadsheet software.

Responsibilities

Manage the revenue analysis function for assigned hospital and ambulatory sites.
Prepare and complete eReserve and analyze eReserve items and trends that significantly affect net revenue.
Review and approve manual adjustments and refunds.
Monitor and analyze accounts receivable and disputes, and assist with bad debt initiatives.
Monitor and communicate non-reimbursable charges, including unsigned ABNs, denials, disputes, and bad debt.
Review proposed managed care contracts and identify implementation issues before contracts are finalized.
Help verify that contract terms are correctly loaded into IMaCs and that claims are properly adjudicated during and after managed care negotiations.
Monitor and review billing, accounts receivable, and reconciliation for hospital-specific contracts.
Work with hospital departments and leadership to resolve revenue cycle issues, including orders, charging, Patient Access, DNFB, DNSP, QS, and disputes.
Work with hospital-related entities, such as clinics and universities, when applicable.
Prepare, facilitate, and follow up on revenue cycle meetings.
Support, direct, or monitor department head meetings, chart audit meetings, compliance committees, charge master reviews and updates, pass-through invoice retrieval, complex in-house patient meetings, revenue cycle implementation initiatives, internal and external audit assistance, and legal engagement for collection issues.