REVENUE INTEGRITY MANAGER - Campbell County Health

• Reports to the Revenue Cycle Director. The Revenue Integrity Manager oversees the Revenue Integrity Analyst who is responsible for assessing, directing and coordinating all aspects of the health systems revenue charging and charge maintenance (CDM) functions. The Manager also has responsibility for new educational awareness and process improvements in the capture and flow of charges from clinical departments through the patient bill/claim. The Director works with the Information Systems Department for the improvement and utilization of the Meditech systems as it relates to revenue improvement and charge capture. Ensures that research related to coding, billing and revenue reporting requirements with department leadership is accurate and compliant with state and federal regulatory requirements; works with the finance areas responsible for strategic pricing to maximize reimbursements and improve reporting for the organization. This position requires consistent review of state and federal requirements related to the coding and billing of all charges for the hospital network. This position requires a clear and creative individual that ensures the changes made do not impact cash flow negatively but optimizes cash for the hospital network. Analyze data to assist Revenue Cycle Director in revenue management. Captures key performance indicators and other suggestions for improvement and decision support. Reports key statistical data regarding vendor partners, tracks their performance, and provides actionable work plans and recommendations around revenue cycle improvements. Works closely with stakeholders from different functional units on topics, including billing, charge capture, coding, edit/denial management, and/or self-pay management. Attends educational in-services as appropriate. Prepares detailed reports as needed to assist leaders in cash and AR reporting. Identifies, analyzes, and monitors issues that affect net revenue, contractual allowances and adjustments. Performs research, audit, and analysis of payer and business data to help identify and understand variances and fluctuations in revenue. Maintains a thorough understanding of patient billing and accounting systems. Keeps current on third party regulatory changes; helps monitor Medicare/Medicaid and third-party reimbursement. Ensures CCH is receiving reimbursement according to payer contracts. Assists with Denial Management efforts.

PRIMARY JOB DUTIES

• Responsible for collecting, documenting and analyzing reimbursement data.
• Reports any reimbursement trends/delays to management. (e.g., billing, denials, claim denials, pricing errors, payments, etc.)
• Prepares daily, weekly, monthly and quarterly reports – including ad hoc reports as needed.
• Assist with generating reports.
• Establish relationships with other CCH departments; build and maintain effective business partner relationships.
• Provides exceptional customer service to internal and external customers.
• Interacts frequently with other Finance staff, IT staff, PFS staff, HIM staff, Patient Access staff and Management.
• Utilizes current payer contract terms and payer mix information to ensure contract compliance.
• Work with and educate Clinicians and Providers on Revenue Integrity issues.
• Support CCMG leadership by working with CCMG clinicians to reviewing/approving policies and procedures.
• Monitors coding and billing updates or changes that could affect revenue and assesses contract terms and methodologies to ensure maximum reimbursement.
• Maintains confidentiality of all personnel and personal health information.
• Analyses and trends claim issues for root cause resolution, including chargemaster corrections, department education or other process improvements.
• Work with Department Directors/Managers and any other staff to do billing reviews and identify opportunities to improve charge capture.
• Understands insurance terms and contract language (e.g., HMO, PPO, Medicare Advantage, % of charges, exclusions, Timely Filing).
• Fluent in understanding Coding rules/concepts; bundling issues, MUE and modifier issues, medical necessity, etc.
• Familiar with CPT, HCPCs, and ICD10 Coding systems.
• Performs other duties as assigned.
• Actively participates in Mandatory Education programs.
• Adheres and actively participates in customer service standards and promotes a service orientation in the performance of job duties and responsibilities and interactions with patients, visitors, and other staff members.
• Must be free from governmental sanctions involving health care and/or financial practices.
• Complies with the hospital’s Corporate Compliance Program including, but not limited to, the Code of Conduct, laws and regulations, and hospital policies and procedures.

JOB QUALIFICATIONS

• 1. Education, Training, Experience:
  • Education: A Bachelor’s degree in healthcare is required. A Master’s degree is preferred. RN or certified Coder is required.
  • Licensure: None
  • Certifications Required: Preferred RHIA, RHIT, CPC or CCS but not required.
  • Experience: Five (5) years’ experience in a hospital setting, healthcare industry preferred. MEDITIECH experience preferred.
• 2. Knowledge, Skills, and Abilities:
  • Must be proficient in medical terminology
  • Current knowledge of revenue cycle processes and hospital/medical billing.
  • Must be proficient in understanding CPT. HCPCs, ICD10 coding conventions.
  • Current knowledge of NCCI edits, Medical Necessity rules as applied in LCD/NCD/LCA/NCA policies.
  • This position requires interpersonal and communication skills, analytical and organizational skills, critical thinking and the ability to meet deadlines.
  • Essential Technical/Motor Skills:
    • Strong computer skills.
    • Computer literate with good keyboarding skills.
    • Typing 40 WPM.
    • Eye-hand coordination, manual and finger dexterity.
    • Ability to run a copier.
    • Ability to answer phones.
  • Interpersonal Skills:
    • Excellent interaction with visitors, patients, coworkers, medical staff, outside agencies effectively and courteously.
    • Strong interpersonal skills. Ability to interact with people of varying backgrounds and education level.
    • Corresponds effectively with outside agencies.
    • Knowledge of English grammar and spelling.
    • Organizational skills.
  • Essential Physical Requirements:
    • Ability to bend or stoop, lift, pull, sit for prolonged periods of time, and stand for prolonged periods of time.
    • Ability to lift or carry 10 pounds or less.
    • Ability to reach above shoulder level.
    • Ability to work in small spaces.
  • Essential Mental Abilities:
    • Attention to detail.
    • Reasoning.
    • Concentration.
    • Time management skills. Work under short deadlines
  • Essential Sensory Requirements: Sufficient vision, hearing, and speech to perform duties.

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