Revenue Integrity Manager

CAN Community Health Inc.•Tampa, FL

3h•Hybrid

About The Position

This position ensures compliance with all regulations, policies, and procedures related to medical billing. The Revenue Integrity Manager reviews systems and processes to identify potential compliance issues, works with appropriate departments to correct such issues, serves as the internal resource for billing-related questions, provides training related to appropriate billing, and works with various departments to ensure billing compliance. In addition, the Revenue Integrity Manager will be responsible for implementing short and long-term plans and objectives to improve billing, coding, denials/rejections, and appeal processes.

Requirements

Bachelor’s degree in healthcare, Business, Finance, or more than 5 years equivalent healthcare experience
Five+ years management experience in a healthcare setting.
Ability to work with minimal supervision.
Strong coaching and development skills with the ability to organize activities for a productive team and lead effectively with time and project management skills.
Ability to research projects using primary sources when appropriate, such as CMS, HRSA, AHCA, etc.
Experience working with medical payers including Medicare, Medicaid, Commercial and third-party administrators.
Strong problem-solving skills with the ability to research complex information, create insights, communicate recommendations, and implement appropriate solutions.
Knowledge of insurance procedures, reimbursement guidelines, and claim filing processes.
Excellent organizational, interpersonal, and communication skills.
Able to regularly review productivity and make staffing adjustments as needed.
High comfort working in a diverse environment.
Ability to effectively communicate both written and verbally.
Ability to effectively utilize problem-solving and decision-making techniques.
Ability to make effective judgments and decisions based on objective criteria.
Strong work ethic
Demonstrated leadership abilities, including team building and collaboration.
Excellent Computer skills and proficiency in Microsoft Office (EXCEL, VISIO, Word, PowerPoint)
General Orientation
HIPAA
HIV/AIDS
Violence in the Workplace
Sexual Harassment
Health Stream Courses as assigned

Nice To Haves

Leadership
Strategic Thinking
Problem Solving
Results Driven
Communication
Interpersonal Skills
Decision Making
Customer Service

Responsibilities

Manage and optimize the revenue cycle process, ensuring accurate and timely billing, coding, and reimbursement.
Ensure compliance with regulatory requirements, coding guidelines, and billing practices (such as HIPAA, CMS regulations, etc.).
Conduct analysis of revenue data, identify trends, and generate reports to support decision-making and improve revenue capture.
Implement strategies to enhance revenue capture, reduce denials, and improve overall revenue cycle efficiency.
Oversee charge capture processes, ensuring completeness and accuracy in coding and billing procedures.
Work closely with coding, billing, finance, and clinical teams to resolve revenue-related issues and streamline processes.
Provide guidance, training, and education to staff on revenue cycle best practices, coding updates, and compliance issues.
Conduct regular audits to ensure billing and coding accuracy, identify areas for improvement, and mitigate compliance risks.
Demonstrate a high level of commitment to customer service in responding timely to the needs of internal and external parties or departments.
Monitors benchmarks and KPIs and uses actionable data for improvement.
Provide daily management and support to team to ensure they are working effectively and correctly completing assigned tasks.
Functions as a working manager as necessary to facilitate trainings, improvements, project work, and revenue cycle optimization.
Supervises, interviews, hires staff, trains new personnel, conducts performance appraisals; promotions, dismissals, PTO requests, and approves payroll.
Practice Integrity and Mission and Value statement.
Communicates effectively and collaborates with other departments to implement regulatory standards that assist in revenue attainment while accurately complying with billing guidelines.
Develops and manages revenue process improvement strategies in support of clinical departments, implementation of information systems, and process initiatives.
Responsible for maintaining system edits to ensure they achieve compliance, payment optimization, and process efficiency.
Responsible for the implementation of the annual fee schedule changes.
Communicates annual coding/fee schedule changes across the organization.
Leads projects with efficiency, project plans, and status reports.
Strong communication and interpersonal skills and the ability to work effectively with a diverse population.
Sites visits as necessary.