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Clinical Revenue Management Specialist
2 months ago
This position reports to the Executive Director of Hospital Revenue Cycle Operations and is responsible for developing, implementing, coordinating, and managing the Revenue Integrity department. Ensures the overall consistency and integration of integrity activities throughout the organization. Develops the alignment of the revenue integrity program with applicable policies and procedures and all applicable laws, standards, and regulations. Works alongside the charge description master (CDM) department to review alignment with finance and reimbursement policies and guidelines. Drives communication of CDM changes to impacted clinical departments. Reviews, revises, and develops policies for adoption via institutional processes, as appropriate, to compliment and reinforce the revenue integrity department. Works closely with executive leadership to ensure that the revenue integrity department meets applicable financial, operational, and legal requirements. Provides periodic reports to executive leadership regarding the nature, progress, and status of the revenue integrity program, any corrective action being taken, and any recommended changes.
Key Responsibilities- Develops, coordinates, implements, and oversees the revenue integrity program and team.
- Acts and leads in a manner that is reflective of the philosophy, vision, and values of NGHS. Integrates these values throughout all initiatives and efforts.
- Uses a proactive leadership style to model and promote a culture of trust and communication. Seeks suggestions and input from staff and colleagues. Promotes an active participation of all staff in decisions that affect them.
- Holds all staff members accountable for following and adhering to all applicable rules, regulations, laws, and guidelines.
- Monitors revenue departments' adherence to charge reconciliation processes and metrics measured by key performance indicators.
- Supports clinical departments related to new revenue initiatives, such as being the subject matter expert in the development of new CDMs to support the new clinical service offering.
- Coordinates with CDM department to ensure necessary changes that affect charge identification, capture, reconciliation and claim progressing are flowing effectively.
- Monitors and assesses integrity risks and ensures that the revenue integrity program is responsive to those risks.
- Provides periodic reports to the Executive Director regarding the nature, progress, and status of the revenue integrity program, any corrective action being taken, and any recommended changes.
- Ensures staff members are knowledgeable about revenue assurance needs and reimbursement issues identified through audits, reviews, and aggregate data analysis.
- Reviews changes in CPT, HCPCS, and revenue codes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursement.
- Develops tools to track and identify potential areas of lost revenue.
- Monitors national, state, and local information to keep current with applicable regulatory and legislative changes and tailors the revenue integrity department accordingly.
- Oversees and coordinates all formal communication with department team and other NGHS staff.
- Works closely with other Department managers to ensure an efficient and effective flow of information leading up to and following the revenue integrity functions.
- Encourages staff to attend educational opportunities relevant to their position and supports their attendance.
- Promotes a service-oriented culture within the organization and assures satisfaction with the quality and amount of support provided for departmental functions, initiative, and projects.
- Intervenes in an accurate and timely manner when pertinent information is required allowing efficient workflow process.
- Researches and recommends various technology tools available to support revenue integrity initiatives.
- Serves as the 1st contact for revenue integrity related issues.
- Serves as the primary support for all revenue integrity related system issues and communicates with ITS to ensure resolution.
- Ensures the appropriate dissemination and communication of all regulation, policy, and guideline changes.
- Participates in the development of goals and objectives for the Department, related to revenue integrity, as well as short-term and long-range planning.
- Participates in preparing Department budget specific to revenue integrity and manage area within budgeted guidelines.
- Mentors staff daily and follows progressive correction policy where indicated.
- Works with Executive Director to resolve discrepancies or staffing issues and addresses noncompliance to policies and/or procedures in a timely manner. Councils staff and administers corrective action as needed.
- Conducts staff performance evaluations. Seeks input from Executive Director, if needed.
- Utilizes time management skills to ensure completion of daily processes.
- Ensures thorough and appropriate documentation for all assigned staff is being maintained.
- Maintains professional development and growth through professional affiliations, seminars, and workshops to keep abreast of trends in Revenue Integrity.
- Responsible for operation of the department and attends meetings throughout the organization as assigned. Completes all employee reports and records according to established time frames: performance reviews, corrective actions and timekeeping. Serves as the key point person and/or assist, as needed, with Revenue Integrity related complaints received by other departments. Responsible for resolving complaints and following up with all parties involved.
