Manager, Revenue Integrity & Optimization – Acute/Professional

🕒 August 21

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $42 - $63 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💹 Revenue Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Trinity Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

📚 Education

🤝 Non-profit

Healthcare • Education • Non-profit

Trinity Health is a Christian K-12 educational institution located in Wichita, Kansas, dedicated to providing a Christ-centered education that nurtures spiritual growth and academic excellence. The academy emphasizes the importance of faith in students' lives, integrating spiritual development with rigorous academic programs and a broad array of extracurricular activities, including athletics and fine arts. Trinity Health fosters a supportive community where teachers and families collaborate to help students develop a personal relationship with Jesus Christ and excel in their studies.

📋 Description

• Provide leadership and day-to-day operational management for local hospital and/or Medical Group Provider Services revenue integrity functions • Motivate staff to achieve high performance and prevent revenue leakage while maximizing regional revenue • Manage the Charge Description Master, pre-bill edits, denial coordination, complex case denials, denial prevention, audits, education, and training • Manage revenue optimization opportunities, including charge control processes • Work with Revenue Integrity and Payer Strategies leadership to apply payer contract terms and align processes • Monitor Medicare, Medicaid, and other payer websites and newsletters for changes affecting charging, coding, and billing • Coordinate denials from the Patient Business Service center and lead root-cause analysis and denial-resolution efforts • Collaborate with multidisciplinary teams to address process and system issues and optimize revenue • Prepare and conduct education on audit findings, regulatory changes, coding updates, and managed-care billing requirements • Develop colleague work schedules and manage team projects and staffing • Gather interdisciplinary feedback, resolve problems, and coordinate corrective actions • Assess departmental development needs and promote decision-making, communication, interpersonal, orientation, and continuing-education opportunities • Hire employees, allocate resources, conduct performance appraisals, provide feedback, mentor and coach colleagues, and manage disciplinary processes • Analyze and present data, develop policies and procedures, conduct special studies, and prepare management reports and KPIs • Maintain knowledge of applicable laws, regulations, and Trinity Health compliance policies • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in Finance, Business Administration, or related field, and 5–7 years of progressively responsible experience in revenue cycle operations, including revenue integrity, or equivalent combination of education and progressive revenue cycle experience • Minimum 3 years of management experience in a multi-facility, integrated health care delivery system or revenue cycle/revenue integrity consulting experience • Knowledge and experience in revenue integrity at an acute and/or physician practice • Strong understanding of appeals, denial management, medical necessity, and coding audits • Ability to read medical charts and dictation and correlate services to charges on UB and 1500 claim forms • RHIA, RHIT, CCS, CPC/COC, or other coding credentials preferred • CDC (Healthcare Compliance Certification) preferred • Experience in Charge Description Master (CDM) maintenance or oversight preferred • Ability to organize, plan, and manage staff in Revenue Integrity and Optimization activities • Knowledge of laws and payer contracts governing hospital and/or physician service billing • Ability to work effectively with physicians, clinicians, office managers, administrators, third-party payers, governmental agencies, and colleagues • Ability to interpret complex issues and clinical processes and recommend improvements • Experience with data collection, analysis, and written reports and proposals • Strong knowledge of DRG, APC, OPPS reimbursement structures, OCE/CCI edits, and DNFB • Ability to concentrate, meet deadlines, manage multiple projects, adapt to interruptions, organize changing priorities, and work in a fast-paced environment

🏖️ Benefits

• Remote work position • Day shift • Professional development activities • Continuing education opportunities • Colleague orientation and training opportunities • Equal Opportunity Employer