Revenue Integrity Program Manager

1 month ago

Other US Location Stanford Health Care Full time

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered.

Day - 08 Hour (United States of America)

This is a Stanford Health Care job.
A Brief Overview
The Revenue Integrity Program Manager is the face of Revenue Cycle Operations for the clinical departments, Chiefs of Staff and the School of Medicine Directors of Finance & Administration (DFA's). The Revenue Integrity Program Manager is responsible for ensuring compliance with government, payer and internal charge capture policies for both Technical (Facility) and Professional Services in a manner that optimizes revenue generation. The Revenue Integrity Program Manager reviews and manages workflows and processes to reduce missed charges, clear edits in work queues, ensure timely charge capture, and identify new revenue opportunities. This position works with NThrive software to manage the Charge Description Master (CDM). This position is also responsible for managing the NThrive Charge Capture Audit results, conducting root cause analyses, and assisting with the reduction of denials.
Locations
Stanford Health Care
What you will do

  • Conducts Prospective reviews of charge capture practices in the clinical departments and reports findings, provides education to staff responsible for charge capture, coordinates charge capture improvement tools in collaboration with Revenue Cycle IT teams, evaluates revenue impact, monitors ongoing compliance and expected versus actual revenue changes. Reports potential compliance issues for further analysis and follow-up to the Compliance Department.
  • Facilitates clinical SME use of NThrive for submitting CDM requests with a focus on regulatory coding, compliance and adherence to SHC internal guidelines regarding CDM maintenance, standard naming conventions and pricing integrity.
  • In collaboration with Compliance Department, provides education to clinical department staff regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliance use.
  • Leads projects to improve revenue compliance, efficiencies in the charge capture process, and CDM charge structures.
  • Performs basic financial analyses to report the impact of payment changes resulting from payer practices and CMS regulation changes. Reports financial impact of charge capture practice changes and corrections to current practices. Communicates findings fully with clinical departments and executive team.
  • Reviews EPIC WQs, conducts research needed to resolve the account issues and identifies gross and/or net revenue benefit expected from all account corrections completed.
  • Reviews NThrive CCA file daily to discover and identify system compliance issues and revenue opportunities, conducts root cause analyses to correct identified charge capture issues, and reports the gross and net revenue differential resulting from each discover and correction completed.
  • Develops criteria for reporting revenue performance to a variety of audiences including Faculty, DFA's, Division and Clinic Chiefs, the Director of Revenue Integrity and others as appropriate.
  • Responsible for presenting reports to a variety of audiences. Such reports will be accompanied by a thorough understanding of content and reasonable explanations for variations from the budget.

Education Qualifications

  • Bachelor's degree in a work-related discipline/field from an accredited college or university (or equivalent combination of education/experience)

Experience Qualifications

  • Five (5) years of progressively responsible directly related work experience

Required Knowledge, Skills and Abilities

  • Ability to analyze revenue data and identify trends and opportunities and the ability to present such data to a variety of audiences
  • Interpersonal skills that allow ease of communication with Clinical staff and faculty
  • Knowledge of coding conventions
  • Current knowledge of third party payer rules and regulations
  • Knowledge of computer systems, specifically, Epic Care and related interfaces
  • Knowledge of management and supervision and the ability to organize staff's work
  • Ability to write, and speak to the analyses performed
  • Ability to provide leadership in problem identification and issue resolution
  • Ability to change the course of events through convincing arguments supported by data
  • Ability to apply Critical Thinking skills to issues and situations
  • Ability to mediate and solve complex work problems and issues
  • Ability to effectively facilitate work groups to successful outcomes

Licenses and Certifications

  • COC preferred . or
  • CPC-H preferred . or
  • CCS - Certified Coding Specialist preferred . or
  • CPC and/or CCSP - Certified Professional Coder preferred . or
  • RHIT - Registered Health Information Technician preferred . or
  • RHIA - Registered Health Information Administrator preferred .

These principles apply to ALL employees:
SHC Commitment to Providing an Exceptional Patient & Family Experience
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family's perspective:

  • Know Me: Anticipate my needs and status to deliver effective care
  • Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
  • Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $ $83.07 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

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