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Manager, Revenue Integrity

3 months ago

Houston, United States Nexus Health Systems Ltd Full time
Job DescriptionJob Description

POSITION SUMMARY:

Under general direction from the Corporate Director, Revenue Cycle – the Manager, Revenue Integrity leads organizational initiatives related to Chargemaster, Facility Coding, Professional Coding, Charge Capture, Charge Reconciliation, Physician Documentation, Payer-specific Coding Requirements, and/or State-specific Coding Requirements. The Manager of Revenue Integrity will develop and maintain relationships with external and internal stakeholders and foster improvements collaboratively across the organization.

JOB SPECIFIC RESPONSIBILITIES:

  • Maintain utmost level of confidentiality at all times.
  • Adhere to health system policies and procedures.
  • Demonstrate ethical business practices and personal actions and adhere to corporate compliance and integrity guidelines.
  • Maintains a sense of professionalism and self-validation.
  • Ability to communicate effectively with all stakeholders across the health system.
  • Responsible for promoting adherence to applicable State/Federal laws and regulations and the program requirements of accreditation agencies and Federal/State and private health plans in requests for third-party reimbursement.
  • Evaluate the use of Revenue Cycle electronic systems and offer recommendations to maximize reporting and revenue integrity accuracies.
  • Acts as a Revenue Integrity liaison with various IT teams handling various EMR modules to set up and maintain accurate charges flow.
  • Coordinates the administrative, legal, operational, and financial issues related to Revenue Integrity data with appropriate departments
  • Participate and lead the development and management of Revenue Integrity projects, workflows, and application builds.
  • Assist with the strategic and financial judgment necessary for profitable organizational growth.
  • Responsible for timely research and evaluation of Medicaid and Medicare regulations, as well as Commercial Payer regulations and changes to optimize reimbursement
  • Supports and participates in continuously assessing and improving the quality of care and services provided.
  • Performs Inpatient and Outpatient coding, including, but not limited to, DX, DRG, CPT, HCPCS, Modifiers, etc.
  • Ensures codes are accurate and sequenced correctly in accordance with government and insurance regulations.
  • Audits clinical documentation and coded data to validate documentation support services rendered for reimbursement and reporting purposes.
  • Participate in denials and appeals related to coding or clinical documentation.
  • Develop and maintain a Revenue Integrity policy and standard operating procedures.
  • Develop and maintain a Charge Description Master (CDM) for administered services and procedures.
  • Identifies KPIs for Revenue Integrity initiatives and collaborates with key stakeholders towards process improvements.
  • Identifies and interprets trends and patterns within Revenue Integrity and recommends resolution
  • Participate in new service or business line research and assessments.
  • Assists and participates in the development of department policies.
  • Develops and maintains revenue Integrity reporting.
  • Perform extensive data mining and testing of financial and clinical information from various decision support tools and software, as needed, for effective and accurate department reporting.
  • Maintains positive working relationships with other organizational departments such as Accounting & Finance, HIM, Compliance, and the Medical Staff to ensure the departments' responsibilities are performed expeditiously and thoroughly.
  • Performs other duties as assigned.

POSITION QUALIFICATIONS:

EDUCATION:

  • Bachelor’s Degree, or minimal two years of relevant work experience.

EXPERIENCE:

  • Minimum three years experience in the same or similar position.

LICENSURE/CERTIFICATION:

  • Current Core Inpatient Coding Certification from AAPC or AHIMA, such as CIC or CCS
  • CPP desired
  • Must pass a criminal background check on an annual basis.