Revenue Integrity Manager

Kaweah Health

3d•$42 - $63

About The Position

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care. It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do — in the health of our patients, our loved ones, and our community. Benefits Eligible Full-Time Benefit Eligible Work Shift Day - 8 Hour or less Shift (United States of America) Department 8595 Revenue Integrity The Revenue Integrity Manager serves as a leader in the revenue cycle and is responsible for supporting the revenue capture and daily charge reconciliation processes by collaborating with the clinical directors of revenue related departments within the health system, to optimize the charge capture process. The Revenue Integrity Manager will be responsible for improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation.

Requirements

Bachelor's degree in Accounting, Business Administration, Healthcare Administration or related field; OR Four to five years healthcare experience may be substituted in lieu of education and experience
Four years healthcare experience in a role related to revenue capture/charging, coding and compliance, preferably in a full-service acute care hospital.
Strong knowledge of CMS regulations and compliance relative to the OPPS and IPPS.
Strong knowledge of correct coding initiatives (CCI) edits and corrective action steps to maintain charging and coding compliance; best practice charge structures by specialty; coding CPT4, HCPCS, Revenue Codes, Modifiers.
Excellent communications skills both verbal and written.
Skill and ability to make decisions and solve problems by identifying creative options and/or solutions.
Excellent analytical and problem-solving skills.
Skill and ability to effectively manage multiple tasks and priorities within a fast-paced environment.
Skill and ability to anticipate, manage, and adapt to change.
Knowledge and skill to gather and summarize data from multiple sources and analyze using common statistical functions.
Skill and ability to operate independently and collaboratively as part of a team.
Skill and ability to manage internal and external relationships.
Skill and ability to lead and take initiative.
Knowledge of Medicare and Medi-Cal Billing Guidelines.
Knowledge of Anatomy and Medical Terminology.
Knowledge of Microsoft Office.

Nice To Haves

RHIA, RHIT, or CCS; or CIC and COC
Master’s degree in Accounting, Business Administration or related field
Previous experience working clinically as an LVN/RN, preferably in an acute care setting.

Responsibilities

Creates and manages a system wide program to identify charge capture opportunities and trends while working directly with both clinical and operational areas to implement any required changes to optimize charge capture and reconciliation while reducing late charges.
Collaborates with and directs department leadership to analyze billing and charge capture procedures and identify problems to increase revenue and reduce unbilled accounts.
Provides education, training and advice to a variety of clinical departments on improved revenue capture processes and procedures related to charge reconciliation and late charge reduction.
Supports and collaborates with Patient Financial Services (PFS) and Health Information Management (HIM) leadership and staff, to resolve billing problems related to the chargemaster and charge capture, as identified by billing/coding edits (EBEW) or information received from intermediaries and other payers.
Develops, produces and presents reports to support both the Revenue Cycle Operations and clinical areas for optimal charge capture reconciliation, project management tasks related to unbilled reduction, and late charge reduction.
Responsible for identifying, planning, developing analytical reports to trend and analyze claims rejected, placed on hold or awaiting to be worked by PFS.
Conducts audits of charge capture practices in the clinical departments.
Reports findings, provides education to staff responsible for charge capture, coordinates charge capture tool improvements, evaluates revenue impact, monitors ongoing compliance and expected versus actual revenue changes.
Develops policies and procedures relevant to revenue enhancement projects, charge compliance, and integration of charge capture compliance in the clinical departments.
Hires, directs, coaches and monitors the performance of all direct reports, to develop and maintain a high performance team that meets organizational and department goals.
Coordinates with Finance and Compliance regarding oversight responsibility for the Chargemaster and chargemaster related functions including annual price adjustments, charge audits, competitive pricing research, reimbursement modeling and forecasting, maintenance of the chargemaster, etc.
Serves in a Project Management capacity on assigned projects, organizing and facilitating teams to achieve project objectives.
Responsible to monitor project plans, timing, deliverables and other key metrics to keep participants on track and to update key stakeholders on progress toward project goals.
Researches and establishes metrics and key performance indicators for areas to facilitate monitoring of ongoing performance.
Develops and presents written and verbal reports at various points during the life cycle of assigned projects.
Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.