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Manager, Revenue Integrity

2 months ago

Skokie, Illinois, United States NorthShore University HealthSystem Full time

Position Highlights:

  • Position: Manager, Revenue Integrity
  • Location: 4901 Searle Parkway, Skokie, IL
  • Full Time
  • Hours:Standard business hours, Monday-Friday

What you will do:

Operations and Monitoring

  • In collaboration with the AVP, Revenue Cycle, analyzes CMS's and the OIG's Annual Workplan and the OIG's Semi-Annual Reports to determine areas at risk for a government coding/billing audit. Prioritizes education based on the internal analysis performed and approval from the Corporate Compliance Office.
  • Monitors HCPCS/CPT changes proactively by performing billing and CDM reviews in collaboration with the Billing and CDM teams, prior to claim submissions. Problem solves any potential billing errors and makes recommendations for change to all impacted areas.
  • Develops financial impact analyses reports based on, billing changes, and/or as needed to support revenue cycle changes.
  • Coordinates charge corrections with the HBO and HIRS as necessary to ensure correction is performed and refund is processed by the HBO to government or third party payors.
  • Collaborates with the Director Coding Compliance, HIRS, Billing, and Rejection/Denials areas to review and trend government and third party payer letters, such as, but not limited to - CERTs, ADRs, Provider Profile Reports.
  • Partners with Patient Financial Services to identify trended reimbursement practices that negatively impact revenue and best resolution for identified issues.
  • Coordinates regulatory oversight of hospital billing and coding activities.

Coding and Billing Education

  • Provides coding education with physicians, mid-level providers, nursing staff, HIRS coding personnel or hospital department management based on internal analysis performed by the Revenue Integrity and Billing Department. Works with providers and/or staff to develop documentation and coding improvement plan. Maintains database of all education sessions
  • Collaborates with Internal Audit to plan and implement education sessions on the audit process, medical record documentation criteria, coding compliance or DRG Assurance.
  • Researches government billing regulations, third party payor guidelines, prospective payment systems, ICD-10-CM and CPT/HCPCS coding guidelines to proactively educate departments impacted by changes.
  • Researches hospital coding and/or billing questions for HIRS coding and hospital billing office staff. Maintains database of all questions and answers from the coding help-line.
  • Investigates coding opportunities and implications, Medicare and managed care regulations/guidelines, reimbursement, available technological support, and potential revenue impact. Maintains a current open and closed issues list, assigns responsibilities and timeframes, follows up with responsible parties, and ensures ongoing, valuable, and tangible progress on resolution of issues.
  • Maintains updates on Medicare Regulatory Changes and provide education to the Hospital and Medical Group

Compliance:

  • Responds to and investigates hospital compliance concerns as assigned by AVP, Revenue Cycle or Internal Audit. Collaborates with appropriate parties to develop and monitor a corrective action plan. Determines if additional education is necessary and coordinates in-services with the appropriate management team
  • Reports compliance concerns to AVP, Revenue Cycle or Internal Audit as appropriate and in accordance with NorthShore University HealthSystem's Corporate Compliance Program.
  • Abides by all of the applicable policies, procedures and guidelines of NorthShore University HealthSystem and assists in the administration of the NorthShore University HealthSystem Corporate Compliance Plan by creating awareness with direct staff.
  • Ensures that actionable items are resolved in a timely or moved to a higher level within the corporate structure of NorthShore University HealthSystem to ensure resolution, including to the Corporate Compliance Office as appropriate.
  • Agrees to prepare and provide data and/or aggregate reports in preparation of the Corporate Compliance Committee or as requested by the Corporate Compliance Office.

Charge Capture Management

  • Assists the Chargemaster Team with identification of new CPT/HCPCS codes to ensure billing systems are updated annually.
  • Participates in the encounter form, super bill, charge capture tools (order entry forms) annual and ad hoc updating process as assigned.
  • Collaborates with Hospital Rev Cycle and Medical Group teams on new procedures and emerging technology, working with vendors and payers on analysis for reimbursement.
  • Monitors department charge reconciliation reports to identify charge capture opportunities.
  • Works with Epic Application Coordinators to assist with annual ICD-10 coding systems build and smart set documentation template tools.

What you will need:

Education: Bachelor's degree required, Masters preferred.

Experience: 5-7 years of related project management experience in coding compliance, outpatient/inpatient coding, chargemaster compliance or the hospital revenue cycle required

Certifications/Licenses: RHIA required, may consider a RHIT with directly related work experience.

Benefits:

  • Career Pathways to Promote Professional Growth and Development
  • Various Medical, Dental, Pet and Vision options
  • Tuition Reimbursement
  • Free Parking
  • Wellness Program Savings Plan
  • Health Savings Account Options
  • Retirement Options with Company Match
  • Paid Time Off and Holiday Pay
  • Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website ) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.