Manager - Revenue Integrity

Luminis Health

Title: Manager - Revenue  Integrity

Department: Revenue Integrity

Reports to: Director – Revenue Integrity

Job Code/Cost Center: 10000-50131-

Position Objective:

Under the direction of the Director – Revenue Integrity, the Manager of Revenue Integrity provides oversight and guidance to hospital revenue cycle activities including, but not limited to, charge capture practices, organizational reviews of the CDM, edit management, work queue monitoring, CDM maintenance, revenue cycle reviews and serves as a liaison between Reimbursement, Finance and Patient Financial Services.  Educates departments on appropriate charging practice and performs claims audits to ensure compliance with policy, laws, and regulations. Reviews, evaluates, and recommends to management, procedures, processes and controls to enhance the audit process to ensure compliance with billing and coding regulations. Oversees the management and reporting of third-party audits. Serves as a resource to the organization for inquiries about compliance with policies and procedures and external laws and regulations related to billing. Is responsible for communicating and coordinating investigative strategies with the functional units to ensure patient services are documented and billed for in accordance with State and Federal regulatory requirements. Responsible for assisting the Director – Revenue Integrity, Director and/or Patient Financial Services and the Compliance Officer in establishing an internal communication network among the various units within the hospital and representing the hospital when interacting with regulatory agencies and other professionals. 

Essential Job Duties:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Performs routine audits for various departments to ensure compliance with plans, policies, and procedures related to charge practices.

1. Provides oversight and guidance over hospital and professional fee charge capture processes to ensure appropriate use and timely charge capture. 
2. Provides oversight of the hospitals and professional charge description masters (CDM) including routine maintenance and organizational reviews of CDM, as needed, to ensure regulatory compliance.  Monitors charges for unregulated entities to ensure appropriate reimbursement. 
3. Serves as liaison between Revenue Integrity dept, Patient Financial Services dept, and Finance to ensure efficient workflow and optimal communication of processes, etc.  Also maintains effective communication and professional relationships with clinical department leadership to ensure optimal revenue cycle performance.   
4. Serves as organization’s lead in HSCRC charge related initiatives including, but not limited to, RVU conversions, etc. 
5. Monitors systeml wide charge capture work queue performance and escalates issues to departmental leadership and Finance leadership.  Communicates and sets expectations for revenue cycle work queue management to ensure timely and accurate charge capture.
6. Participates with leadership in evaluating existing or establishing new revenue cycle infrastructure for services including being an active participant on multidisciplinary teams (with IT, PFS, clinical leadership). Performs research on billing and coding regulations for services. 
7. Performs and/or oversees routine revenue cycle reviews in support of the organizational Corporate Compliance program.  Reports findings of reviews to senior management and Corporate Compliance committee and participates in setting corrective actions for leadership. 
8. Oversees the management and reporting of third-party audits. Reports findings to appropriate senior management. Provides education to clinical departments based on audit findings to reduce future denials.
9. Provides guidance to the VP of Revenue Cycle, Compliance Officer, Director of Patient Financial Services and/or Director – Revenue Integrity with the investigation of any issues of non-compliance and assists in the development and implementation of appropriate corrective regulatory procedures.
10. Reads appropriate publications to keep current with industry trends, rules and regulations.
11. Strong analytical skills required to direct regulatory monitoring and to resolve conflicts between external payers and internal hospital departments, such as financial analysis of patient bills and medical analysis of patient`s medical history.

Educational/Experience Requirements:

• Bachelor’s Degree required; in lieu of degree, 10 years direct revenue cycle experience.
• Knowledge of Medicare billing and third-party payer coding/billing regulations
• Prefer candidates with Team Lead and/or Supervisory experience.
• Two years of direct auditing experience can replace clinical experience.
• Effective public speaking skills and the ability to articulate complex regulatory information in understandable, layman's terms.
• Work requires specialized clinical and billing knowledge.

Required License/Certifications: 

Certified Professional Coder (CPC)

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.

Physical Demands –

Light work

Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

Luminis Health Benefits Overview:
• Medical, Dental, and Vision Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Employee Assistance Programs and more
*Benefit offerings based on employment status