Manager Revenue Integrity

2 weeks ago

Omaha, United States Children's Hospital & Medical Center Full time
Job Description

FT, Mon - Fri, days

At Children's, the region's only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team-and join us in providing brighter, healthier tomorrows for the children we serve. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview
The Manager of the Revenue Integrity role is to improve processes and support optimal revenue cycle performance for the system. Oversee and ensure accuracy and compliance in charge capture processes with a focus on maximizing financial performance while following government and payer regulations. This role is to develop, implement, and maintain an organization-wide revenue reconciliation process, develop a robust revenue cycle training program, and provide oversight of clinical appeals, and payer audits. Other responsibilities include leading the Denial Prevention Committee, monitoring of clinical department charge master functions, and monitoring revenue integrity Work queues.

Essential Functions
  • Lead the planning, implementation, and maintenance for initiatives related to revenue cycle integrity. Assure a sound business processes to maximize revenue for the organization, define operational standards, organize departmental activities, and sets performance standards. Key areas of focus include: •Organization-wide charge reconciliation process •Robust training program for revenue cycle functions •Accuracy and integrity of the CDM and professional fee schedule through coordination with departments and clinicians to implement required changes to charge documents, charge capture processes, and order entry procedures. •Service as Member and Coordinator of Denial Prevention Committee
  • Develops and maintains Revenue Cycle departmental policies, procedures, and objectives. Develops a control and review mechanism to ensure compliance. Ensures departmental compliance with Children's policies and procedures and assuring key metric are met. Synthesizes all available information to make informed decisions. Fosters creativity, innovation and divergent thinking in self and others. Manages complex situations using multiple sources of information and advice. Prioritizes, proposes, and collaborates with Hospital Billing/Collections, Patient Registration, HIM, Children's Physicians, Children's Specialty Physicians, Financial Systems Manager and others in regard to operational projects and system changes based on careful analysis of current processes.
  • Responsible for interviewing, selecting, rewarding, coaching, disciplining, and terminating employees in the department to ensure proper functioning of the area. This includes working with the Financial Systems Manager to set performance-related criteria and standards as well as procedures for each incumbent in the department. Responsible for prompt completion of all performance evaluations and productivity statistics. Responsible for setting and monitoring departmental productivity standards as well as assuring the department's goals meet, or exceed, established standards.SResponsible for interviewing, selecting, rewarding, coaching, disciplining, and terminating employees in the department to ensure proper functioning of the area. This includes working with the Financial Systems Manager to set performance-related criteria and standards as well as procedures for each incumbent in the department. Responsible for prompt completion of all performance evaluations and productivity statistics. Responsible for setting and monitoring departmental productivity standards as well as assuring the department's goals meet, or exceed, established standards. Personnel Managementevaluations, setting goals, dissemination of information, coaching, addressing performance issues/routine correction actions, and recommending termination of employment. •Makes salary recommendations. •Submits notifications for personnel actions (e.g., status changes, terminations). •Makes recommendations for human resource needs. Operational/Financial Management •Responsible for the implementation and execution of business plans or activities for the department. May assist in the development of business plans. •Makes decisions guided by the business plan and resource availability that impacts service levels and the team's ability to meet objectives. •Analyzes processes and procedures and makes recommendations and/or decisions on guidelines for daily processes/activities within department. May recommend policy changes related to the department. Implements new or revised policies, processes, and procedures within the work area. •Applies business and management expertise to identify problems/opportunities, determine solutions, and measure results. •Ensures compliance with quality assurance, safety practices, policies, regulatory, and legal requirements.
  • Works cooperatively with other hospital departments in obtaining demographic and charge information for purposes of timely and accurately billing. •Provides feedback to departments, as necessary, about charging concerns. •Responsible for establishing and maintaining excellent public relations with hospital departments, physicians, third party payers and customers.
  • Reviews with the Financial Systems Manager the monthly departmental reports and jointly presents to Director of Revenue Cycle Operations. Monthly reports include but are not limited to budget variance reports, monthly accounts receivable reports including a review of the age trial balance, aging detail, longitudinal accounts receivable analysis, accounts receivable analysis by payor, employee and staff productivity reports and additional ad-hoc reports as required from time to time.
  • Stays abreast of changes in the industry by keeping current with CMS, Medicaid, HIPAA and payor billing regulations as well as market changes. Holds self accountable for professional development through active participation in HFMA, CHCA and other professional organizations.
  • Regular attendance at work is an essential function of the job.
  • Perform physical requirements as described in the Physical Requirements section
Education Qualifications
  • Bachelor's Degree from an accredited college or university in business or health care Required and
  • Equivalent relevant work experience may be substituted for education. Required
Experience Qualifications
  • Minimum 5 years' experience in healthcare billing, healthcare collections, healthcare finance, healthcare registration, or healthcare IT Required and
  • Minimum 1 year supervisory or lead experience Required
Skills and Abilities
  • Possesses comprehensive knowledge of hospital and clinic revenue cycle operations
  • Knowledge of hospital and physician billing, collection and reimbursement requirements and standard practice.
  • Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental program regulations.
  • Knowledge of CPT, HCPCS and revenue codes and their effect on hospital reimbursement.
  • Ability to communicate effectively both verbally and in writing.
  • Ability to pay close attention to detail and work with minimal supervision.
Licenses and Certifications
  • Certification as a RHIA Reg Health Inform, Admin, RHIT Reg Health Inform. Tech, CPC Certified Professional Coder, CCDS Doc Cert Clinical Doc SPCLST Preferred and
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure Preferred


Children's is the very best for kids and the very best for your career At Children's, we put YOU first so together, we can improve the life of every child

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