Job Description

Summary:

The Manager of Revenue Integrity is responsible for overseeing the daily operations, performance, configuration, and development of assigned applications to ensure alignment with departmental goals and objectives. This role manages a team of Revenue Integrity Analysts who provide technical expertise to support charge capture processes, system functionality, and compliance requirements. The Manager also designs, implements, and tests controls to optimize revenue capture, enhance net revenue, and ensure regulatory compliance across people, processes, and technology.

Responsibilities:

• Manages the planning of application development and deployment; educates and promotes adherence to the organization's software compliance standards within the team.
• Strategic focus: based on regulatory and industry updates, MHS strategic initiatives, end-user feedback, and other information, identifies and achieves opportunities to improve charge capture efficiency and accuracy, eliminate missed charges, eliminate billing rework, and improve MHS net revenue.
• Keeps current, timely reads, and analyzes Medicare, Medicaid, and other technical guidance to determine how they affect Memorial Healthcare System (MHS) capture. Develops, recommends, and implements plans to comply with regulatory updates as approved by the Director of Revenue Integrity and in collaboration with responsible MHS leaders.
• Develops annual CDM CPT/HCPCS updates and implements as approved by the Director of Revenue Integrity. Includes working with operational departments to identify applicable new or revised codes. Oversees the maintenance of CDM-driven CPT/HCPCS coding requirements. Develops annual CDM Fee Schedule updates and implements as approved by the Director of Revenue Integrity. Updates Price Transparency Standard Charges file in accordance with regulatory requirements.
• Manages and monitors staffing activities including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
• Periodically tests samples of departmental charges to evaluate whether staff members are performing correctly, and controls are operating as designed. Works with RCM and departmental staff to provide as-needed retraining as well as regular periodic updates for all charge capture staff.
• Monitors and provides training, support and troubleshooting to both application teams and end-users to facilitate proper usage and continuous learning. Manages applications projects including workflow analysis, end-user validation, acceptance, go‑live, and maintenance using standard project management methodology. Sets project deadlines and deliverables for specific modules and analysis. Manages the debugging and enhancements processes including the design and upgrades to existing systems in order to ensure up‑to‑date and reliable functionality.
• Utilizes subject matter expert skills to assist MHS leaders with analyses of billing, coding, and documentation requirements for payer coverage and payment of services affecting their service lines and initiatives.
• Designs and evaluates the tools and processes used to capture charges in each MHS department. Updates the design of tools to empower departmental staff to accurately post charges efficiently, without rework. Designs and implements controls to empower departmental leaders to ensure staff have captured charges accurately and timely. Ensures Epic charge-related work queues are timely and correctly cleared.
• Selects opportunities identified by team to implement and improve existing processes using information technology and ensures alignment with strategic initiatives of the organization.

Education and Certification Requirements: Associates (Required)Epic Charge Router Certification (EPIC CHG ROUTER) - EPIC Certification (EPIC), Epic Resolute Billing Certification (EPIC BILLING) - EPIC Certification (EPIC)

Required Work Experience: Minimum of five (5) years' Epic charge master (preferred) and/or billing experience. Able to build charge records (EAP) and controls (charge router, charge handler, and revenue guardian). Minimum of three (3) years’ experience of supervising/managing a team.

Other Information: Additional Education Info: Associate's degree required; Bachelor's preferred Certification Requirements: Epic Resolute Billing Certification Epic Charge Router Certification Candidate must have or be pursuing a coding credential (AHIMA or AAPC) which must be obtained within a year of taking the position.

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