Revenue Integrity Supervisor

OMNI FAMILY HEALTH•Bakersfield, CA

3d•$70,304 - $87,880

About The Position

Under the supervision of the Manager, Coding and Compliance, the Revenue Integrity Supervisor provides revenue integrity support and leadership to Omni Family Health’s network of health centers in California’s Central Valley. As part of the Fiscal Department, this role oversees the accuracy and compliance of charge capture, documentation, coding, and billing of clinical services. The position safeguards organizational revenue by monitoring discrepancies, preventing revenue leakage, and ensuring adherence to regulatory and payer requirements. It emphasizes prospective review and continuous process improvement to identify issues before claims are affected, optimize charging workflows, and ensure services are correctly documented and billed. The Supervisor leads the revenue integrity program and staff, oversees quality assurance, audits, compliance, reporting, training, and corrective actions, and collaborates with departments across the organization to improve revenue cycle performance. The role may require some travel and includes additional responsibilities related to HIPAA, regulatory compliance, quality improvement, electronic health record use, Patient Centered Medical Home participation, and audit support.

Requirements

Associate’s degree in Pharmacy, Health Information Technology, Business, Healthcare Administration, or a related field.
Certification such as CPC, CCS, CRCR, COC, or another related certification.
Four years of progressive experience in revenue cycle management, medical billing, coding, reimbursement, revenue integrity, or a related healthcare field.
Knowledge of CPT, HCPCS, ICD-10-CM, E/M documentation requirements, and related billing regulations.
Working knowledge of 340B regulatory guidance, billing practices, pharmacy reimbursement methodologies, and HRSA audit preparedness.
Knowledge of CMS, Medicare, Medi-Cal, FQHC reimbursement requirements, payer guidelines, and revenue cycle compliance standards.
Familiarity with split-billing software, reporting tools, and electronic health record systems such as NextGen.
Proficiency in Microsoft Office Suite, including Word, Outlook, and Excel.
Leadership and staff development skills, including the ability to supervise, coach, and develop employees while fostering accountability and continuous improvement.
Advanced analytical and problem-solving skills, including the ability to interpret complex billing, reimbursement, and utilization data and provide actionable recommendations.
Strong knowledge of revenue cycle operations, reimbursement methodologies, and regulatory compliance requirements.
Ability to evaluate workflows, manage multiple priorities, and implement process improvements in a fast-paced healthcare environment.
Collaborative and influential leadership style, strong communication skills, and ability to work effectively across clinical, operational, financial, and revenue cycle teams.
Ability to maintain confidentiality, support Omni’s mission, and relate to the public without regard to protected or socioeconomic characteristics.

Nice To Haves

Experience in a Federally Qualified Health Center, multi-clinic healthcare organization, or nonprofit healthcare setting is preferred.

Responsibilities

Perform Revenue Integrity Coordinator duties, including charge capture review, charge reconciliation, denial prevention, compliance monitoring, reporting, and revenue integrity improvement activities.
Provide operational leadership and oversight of the revenue integrity program to ensure accurate, timely, and compliant departmental work.
Supervise Revenue Integrity staff, including training, coaching, scheduling, performance management, and disciplinary action.
Ensure appropriate staffing, workflow coverage, workload distribution, and prioritization to maintain productivity, quality, and service standards.
Serve as the subject-matter expert for charge capture, E/M leveling, FQHC PPS and SPM reimbursement requirements, and RCM compliance standards.
Develop, implement, and maintain revenue integrity policies, procedures, workflows, and internal controls.
Oversee quality assurance reviews of documentation, charge capture, coding practices, reimbursement trends, and claim edits.
Ensure correct application of CPT/HCPCS, ICD-10-CM, and modifiers specific to FQHC billing.
Ensure compliance with federal, state, payer, and program-specific regulations and organizational policies.
Lead internal audits and support external audits, payer reviews, and regulatory assessments by ensuring documentation is accurate, complete, and available.
Oversee corrective action planning and implementation related to audit findings, compliance concerns, reimbursement issues, and process deficiencies.
Monitor departmental metrics, reimbursement trends, denial patterns, charge lag, revenue leakage, and other key performance indicators.
Analyze operational and financial data and recommend workflow improvements, reimbursement optimization, and compliance initiatives to leadership.
Prepare and present revenue integrity reports, findings, and recommendations to leadership and other stakeholders.
Collaborate with Revenue Cycle Management, Managed Care, Finance, Pharmacy, Information Technology, Clinical Operations, and other departments to improve performance and resolve challenges.
Develop and facilitate training and educational resources on documentation, charge capture, reimbursement requirements, and compliance.
Attend management meetings and contribute to organizational planning, operational initiatives, and strategic goals.
Support the organization’s mission, vision, and core values while delivering superior customer service, and work with corporate branches, divisions, and departments in accordance with policies and procedures.
Perform other duties and responsibilities as assigned by the Manager, Coding and Compliance.
Travel as required.
Maintain awareness of and compliance with HIPAA regulations and requirements.
Participate in QA/QI activities and contribute to organizational quality improvement initiatives.
Learn and use the electronic health record and related components as required, including NextGen, PMS, QSI, and other applicable electronic features.
Participate in Omni Family Health’s Patient Centered Medical Home program.
Contribute to required HRSA, OSV, Joint Commission, and other audit events.
Protect the confidentiality of general personnel and patient-related information, promote Omni’s mission, and relate respectfully to the public regardless of race, ethnicity, religion, age, sex, disability, or economic status.