Manager, Quality – Revenue Integrity

🔥 2 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Ovation Healthcare

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 45 years

⚕️ Healthcare Insurance

☁️ SaaS

📚 Education

Healthcare Insurance • SaaS • Education

Ovation Healthcare is a leading provider of shared services for independent hospitals and health systems. With over 45 years of experience, the company enhances hospital and system performance through services like leadership advisory, supply chain management, revenue cycle management, technology services, and clinical care management. Ovation Healthcare is dedicated to supporting the financial and clinical needs of hospitals while preserving their focus on patient care and community wellness. Their educational programs and consulting services aim to strengthen hospital operations, making healthcare delivery more efficient and effective.

📋 Description

• Develop, implement, and maintain revenue integrity programs to ensure accurate charge capture, coding, billing, and reimbursement. • Identify, analyze, and mitigate revenue leakage across inpatient, outpatient, and ancillary services. • Conduct regular audits of charges, coding, billing edits, and reimbursement patterns. • Collaborate with facility HIM & Compliance teams to ensure completeness and accuracy of medical records. • Support accurate DRG/APC/ProFee assignment and appropriate reimbursement. • Evaluate coding trends and provide education to coding staff, clinicians and other contacts. • Ensure compliance with federal, state, and payer regulations (CMS, HIPAA, OIG, etc.). • Establish and maintain internal audit programs for clinical documentation, coding accuracy, and billing compliance. • Prepare documentation and support external audits and regulatory reviews.

🎯 Requirements

• 5–8+ years of experience in healthcare revenue cycle, coding, auditing, or compliance • Strong experience and expert working knowledge with hospital billing (inpatient/outpatient), clinic, ancillary and other services areas and applicable code sets (ICD-10, CPT, PCS HCPCS, Modifiers), and payer regulations • 3+ years in a leadership or managerial role preferred • One or more of the following: RHIA (Registered Health Information Administrator): RHIT (Registered Health Information Technician) CCS (Certified Coding Specialist) CPC (Certified Professional Coder) CHC (Certified in Healthcare Compliance)

🏖️ Benefits

• Remote role