Revenue Cycle Claim Integrity Manager

2 months ago

West Jordan, United States Granger Medical Full time
Job DescriptionJob Description

Revenue Cycle Claim Integrity Manager


Overview: Granger Medical Clinic is looking to hire an experienced Revenue Cycle Claim Integrity manager that can manage and oversee coding and billing/claim processes, EDI functions and claim needs while supporting team members of respective teams. Must hold current AAPC coding certification with experience managing team members and processes, ensuring team members perform their duties and responsibilities accurately according to healthcare regulations. This candidate will need to provide training, education and conduct and facilitate internal audits of team members and physician/ providers, while working to help establish policies and procedures that improve medical records and coding accuracy.


Location: Granger Medical Headquarters, 7181 S. Campus View Dr., West Jordan, UT 84084


Essential Functions and Duties:

  • Provide coding support to coders, supervisors, and other RCM team members, as necessary.

      • Research and respond to issues and requests on a timely basis.

      • Provide routine feedback and training.

      • Supervises annual audits for coders to maintain a high level of accuracy and compliance.

  • Provide support to the Audit/Education Team.

      • Supervise annual provider audits.

      • Supervise prospective/retrospective audits.

      • Ensure Audits are geared to ensure compliance and accuracy.

      • Gear audits to OIG worklist as needed.

      • Supervise Coding Quality Audits

  • Provide coding support to clinics and providers.

      • Research and respond to issues and requests on a timely basis.

      • Provide feedback and training as necessary.

      • Analyze coding patterns to drive improvements.

      • Generate top 10 CPT usage and compare with other specialties to help analyze risk.

      • Meet with providers and practice managers on a scheduled and ad hoc basis.

  • Take on special projects as assigned focused on improving the financial performance of the clinic.

      • RCM/Operations related Policy and Procedure needs.

      • Help improve revenue generation through correct documentation/coding practices.

      • Improve workflow processes.

      • Reduce costs associated with RCM services.

  • Identify opportunities to improve processes, increase clean claim rates, increase reimbursements, and reduce back-end denials. Analyze denial data and develop systems and processes to drive improvement in the following areas:

      • Clinic

      • Provider

      • Coder

      • Data input

      • Claim submission.

      • Appeals submission.

  • Develop and manage pro-active process to analyze provider and payer trends that impact financial performance of the clinics.

      • Analysis of cost and reimbursement

  • Track key metrics of the RCM process, insuring the maximization of the financial performance of the Claim Integrity Team.

  • Assist with process assessments of the revenue cycle operations in practice areas to identify process improvement opportunities. Functions as the point of contact for revenue cycle process assessments as assigned.

  • Collaborates with appropriate resources to provide guidance and timely responses to practice inquiries about pre-billing hold and denials.

  • Works collaboratively across Revenue Cycle, Operations, IT and Executive Team toward meeting the institutional goal of increasing revenue and decreasing outstanding AR.


Education and Experience:

  • AAPC or AHIMA CPC-Certification.
  • A clear understanding of coding compliance rules/regulations.
  • 5+ years Coding management experience.
  • 5+ years of billing experience.
  • Project Management experience.

Granger Medical Clinic offers competitive wages and excellent benefits. Benefits include:

  • Vision
  • Dental
  • Medical
  • Sick Leave
  • Paid Time Off
  • Life Insurance
  • Paid Maternity Leave
  • Tuition Reimbursement
  • Short- and Long-Term Disability
  • Employee Assistance Program (EAP)
  • Health Savings and Flexible Spending Accounts
  • 401(k) with a Company Match, Profit Share, and Safe Harbor Contributions

Granger Medical Clinic provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Granger Medical Clinic complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation and training.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regards to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability status, genetic information and testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law.


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