Revenue Integrity Manager

Description

JOB SUMMARY

Oversees professional staff responsible for managing, coordinating, and implementing Charge Description Master (“CDM”) and charge capture initiatives and processes to ensure revenue management and revenue protection. Serving in a senior leadership capacity, has direct interaction and interface with internal and external executive level staff. Facilitates CDM and charge capture education; ensures adherence to government/non-government regulatory directives; ensures appropriate levels of control are established to satisfy audit/review requirements; and facilitates revenue management communications and information flow. Oversees maintenance of accurate and timely patient accounting system(s) changes/updates to sustain data integrity and to facilitate claims processing; ensures quality reviews occur to identify and minimize system errors. Plans revenue management strategies as identified in data/report analyses to ensure consistency/standardization, to identify improvement opportunities, and to facilitate appropriate knowledge transfer. Plans, prepares, and administers annual budget; develops and maintains budgetary controls; balances department needs with Conifer annual budget goals.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Serves as a resource and in a consultative role to various levels of customers; works closely and collaboratively with other internal departments.
• Manages a professional team to evaluate, review, plan, implement, and report various revenue management strategies to ensure CDM integrity; to identify charge capture improvement opportunities; resolve billing edits and to facilitate appropriate education.
• Evaluates and maintains workflow processes to ensure efficiencies; works with all personnel involved in the revenue cycle to optimize CDM interfaces, billing edit resolution and charge capture processes.
• Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact and to ensure optimal revenue management; continually reviews and monitors billing and coding changes affecting CDM and charge capture processes to ensure accurate claims production, appropriate distribution of information, and to identify target areas for education.
• Provides incident management and problem resolution; views incidents and problems from a systemic perspective to determine enterprise-wide solutions; oversees implementation of recommendations and monitors results to prevent recurrence; investigates complex issues as required.
• Manages/oversees special projects and special studies as required for new clients, system conversions, new facilities/acquisitions, new departments, new service lines, changes in regulations, legal reviews, or other projects including, but not limited to:
  • Oversees pricing initiatives such as strategic pricing, across-the-board increases, tiered pricing, pricing transparency; conducts interim pricing reviews and performs financial analyses for strategic initiatives.
  • Manages implementation of CDM and/or charge capture corrective measures and monitoring tools to ensure sustainability of changes; reviews and monitors statistics and key performance indicators to identify improvement opportunities and ensure compliance with regulatory/non-regulatory directives.

FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense):

• This position may be required to monitor and explain expense variances to budget on a regular basis

SUPERVISORY RESPONSIBILITIES

This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

• No. Direct Reports (incl. titles) Charge Review Specialist I-II, Revenue Integrity Analyst I-III, Charge Audit Specialist

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Strong interpersonal communication and presentation skills, effectively presenting information to executives, management, facility groups, and/or individuals
• Ability to present ideas effectively in formal and informal situations; conveys thoughts clearly and concisely
• Ability to respond in a professional manner to complex inquiries from various levels of personnel
• Accepts personal responsibility for the quality and timeliness of his/her work; establishes due dates for projects and assignments and meets those dates; efficiently organizes activities
• Ability to define problems, collect data, establish facts, draw valid conclusions, and make recommendations for improvement
• Adapts easily to changing conditions and work responsibilities; works well with people of vastly differing levels, styles, and preferences
• Understands external and internal drivers affecting revenue management
• Ability to read, review, analyze, and interpret a variety of state/federal regulatory information and managed care contracts and the affect on appropriate claims production including multiple patient accounting systems, clinical/order entry systems, ancillary systems, and CDM
• Ability to utilize and research various published resources, appropriate reference materials, Internet resources, seminars, and other associated information sources to continually stay abreast of changes in regulatory information
• Working knowledge in MS Office Applications (Excel, Word, Access, Power Point)

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience required to perform the job.

• Bachelor’s degree or higher; related experience may be considered in lieu of degree
• Prior supervisory experience required
• Minimum of five years healthcare-related experience required
• Working knowledge of laws and regulations pertaining to healthcare industry required
• Prior healthcare financial experience or related field experience in a hospital/integrated healthcare delivery system required
• Prior CDM or charge capture experience required
• Consulting experience a plus

CERTIFICATES, LICENSES, REGISTRATIONS

• Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, CPC-H, CCS highly desirable

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit for long periods of time; use hands and fingers; reaching with hands and arms; talk and hear.
• Must frequently lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision
• Some travel required

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Normal corporate office environment

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $81,952.00 - $122,907.00 annually. Compensation depends on location, qualifications, and experience.
• Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, life, and business travel insurance
• Management time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.