Manager Revenue Integrity

🔥 0 minutes ago

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $42 - $63 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💹 Revenue Operations

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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 revenue integrity functions • Motivate staff to achieve high performance and collaborate with stakeholders to prevent revenue leakage and maximize regional revenue • Manage the Charge Description Master, pre-bill edits, root cause analysis, denials coordination with PBS, complex case denials, denial prevention, audits, and education and training • Manage revenue optimization opportunities, including charge control processes • Optimize staff and revenue performance through process redesign, policy and procedure implementation, communications, continuing education, professional development, empowerment, and feedback • Ensure understanding and application of payer contract terms and alignment with processes • Monitor Medicare, Medicaid, and other payer websites and newsletters for changes affecting charging, coding, and billing; apply updates for compliance and revenue optimization • Coordinate denials from the Patient Business Service center, ensure timely resolution, identify root causes, and participate in multidisciplinary denial teams • Collaborate across departments to address denial and pre-bill edit causes and optimize revenue • Prepare and conduct education related to audit findings, regulatory changes, coding updates, and managed care billing requirements • Develop colleague schedules and manage team projects and interdisciplinary relationships • Involve interdisciplinary and medical staff in decision-making and coordinate problem resolution and corrective action • Assess department development needs and promote professional development, orientation, and continuing education • Hire employees, allocate resources, conduct performance appraisals, provide feedback, mentor and coach colleagues, and manage disciplinary processes • Analyze and display data, develop policies and business documentation, conduct special studies, and prepare management reports and KPIs • Maintain knowledge of applicable laws, regulations, and Trinity Health compliance policies and Code of Conduct

🎯 Requirements

• Bachelor's degree in finance, Business Administration or related field and a minimum of 5 to 7 years of progressively responsible experience in revenue cycle operations, including revenue integrity, or equivalent combination of education and progressive revenue cycle experience • Minimum of 3 years of management experience in a multi-facility, integrated health care delivery system or revenue cycle or revenue integrity consulting experience • Knowledge and experience in revenue integrity at an acute 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 claim forms (UB and/or 1550 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 of a large healthcare acute and professional billing organization • Knowledge of laws and payer contracts governing billing of hospital and/or physician services • Ability to work effectively with physicians, clinicians, office managers, administrators, third party payers, governmental agencies and colleagues • Ability to understand and 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 and prebill edits including OCE/CCI edits and DNFB • Ability to thrive in a fast-paced, multi-customer environment with conflicting needs and potentially varied and extended hours

🏖️ Benefits

• Work Remote Position • Continuing education and professional development activities • Colleague orientation and continuing education opportunities • Equal Opportunity Employer

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