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A.R.E.). We are Magnet ® and received the 2020 Press Ganey Leading Innovator award for our rapid adoption and implementation of healthcare solutions during the COVID-19 pandemic.
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Job Summary :
The Revenue Integrity Manager is responsible for providing direction in developing and maintaining systems, processes and work flows, for the timely and accurate recording of System revenue in regards to charge capture and payment analytics.
Manages the Revenue Integrity Department analyst(s) in order to proactively identify and eliminate issues within the revenue cycle.
This position provides management and coordination of education, implementation support and serves as a facility liaison to the Bristol Health staff as it relates to charging, late charges, billing and coding issues and reconciliation efforts that department staff should complete to meet billing timeframes.
The position works directly with clinical managers of revenue generating departments and has collaborative relationships with Patient Financial Services, Decision Support, Health Information Management, Contracting and Compliance.
The Revenue Integrity department ensures that Revenue Cycle staff and their activities are in compliance with applicable State and Federal laws, regulations and organizational policies.
It achieves this by collaborating with Revenue Cycle leadership and / or committees and processes for Hospital, Physician, Homecare and Hospice, SNF, and EMS services.
Also provides supporting oversight and management of the Billing, Charge Description Management, Coding, and Financial Service functions.
Essential Job Functions and Responsibilities :
As the Revenue Integrity System Manager, you will assist in upholding Bristol Health administrative and fiscal excellence within the Revenue Cycle by providing expertise to assist and educate appropriate staff on charging and coding standards, ensuring data integrity and the accuracy of charging practices.
Evaluate research and analyze coding, revenue and billing to ensure compliance with all payer requirements and determine patterns of charging that will increase the propensity for payment of charged services.
Assist in the development and maintenance of policies to facilitate a better understanding of government regulations related to charging, coding and billing.
Assists as directed in review of charges and clinical data from targeted points of care to compare services charged verses services recorded.
This can be done by maintaining the organizations charging matrix in order to evaluate charge detail issues by department)
Responds to results and report findings from the Sr. Revenue Integrity Analyst(s) identifying late, erroneous or missing charge postings, with follow up analysis, development, and implementation of recommendations and actions plans to minimize late or missing charges.
Responsible to document and report findings, recommendations, corrective actions in support of improved charge capture, APC / DRG payment neutrality or improvement, developing processes for new services within the organization to insure proper processing, capture and billing of services.
Work with clinical department representatives to analyze charge capture process and charging requirements as per the CDM.
Work with clinical departments to plan, correct and implement new or revised process in a timely manner to insure compliance and revenue neutrality (as possible).
Responsible to document and report findings, recommendations, corrective actions and outcomes related to overall work efforts.
Supports automated efforts where possible to minimize use of manual charge entry and departmental variances from the organization standard.
Interacts extensively with clinical staff, clinical support staff, to identify areas of missing charges and ensure compliance of charging practices and policies, and transfer of expert knowledge of current OPPS rules, CCI edits, and CMS reporting requirements to Revenue Integrity unit staff.
Proactively represents the interests of the department in meeting with department managers and clinical staff to educate and ensure an efficient and continually improving flow of charge information from the point of care to the charge master.
Brings to the team or develops expertise in one of more clinical area where charges are complex and varied such as : Pharmacy, Cardiology / Cath Lab, Interventional Radiology, Operating Room, Laboratory, and Emergency Services.
Supports the Sr. Revenue Integrity Analyst(s) and department leadership with the development and knowledge base for the following : Assistance with the development of new service lines and / or departments in terms of deployment of Revenue Integrity standard procedures;
Provides expertise in a given area on an as needed basis related to charging issues or CPT / HCPCS / Rev. Code concerns;
and Development and deployment of customer service tools and techniques, such as a dedicated e-mail box for facility use and tracking.
SKILLS & QUALIFICATIONS :
Knowledge of revenue cycle processes, medical billing and coding processes, basic accounting principles, quantitative decision making and process analysis through formal education or two years of work experience.
Prior Meditech experience (preferred) with CDM or Patient Accounting.
Must be able to understand and work with ancillary systems impacting charge capture.
Advanced level of communication, interpersonal, problem solving and organizational skills in order to maintain a high level of production and accuracy in an extremely task driven environment.
Advanced computer analytical skills to create and maintain reports and provide analysis (1) in support of project initiatives and (2) to resolve complex charging / revenue issues (Microsoft Excel, Word, Power Point,Google, etc.).