Manager, Professional Revenue Integrity
Memorial Hermann Health System
full-time
Posted on:
Location Type: Hybrid
Location: Houston • Texas • United States
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About the role
- Overseeing and managing all aspects of professional charge functions to ensure the integrity of the organization’s revenue
- Summarizing findings to support the development of processes and procedures
- Collaborating with Revenue Cycle, Clinical Departments, and Finance to ensure accurate revenue capture, compliance, and optimization
- Supporting the ongoing integrity of charge activity inclusive of technical and operational workflow and functionalities
- Managing all facets of professional revenue integrity processes to achieve and exceed best practice benchmarks
- Serving as liaison between revenue cycle and clinical departments
- Ensuring a process is in place to reconcile charges back to the daily ancillary and clinic patient schedules
- Monitoring daily reconciliation reports to assist departments in maintaining accurate and timely charges
- Maintaining current working knowledge of billing systems, claim submission, remittance advices, explanation of benefits, reimbursement methodology, payer systems, payer requirements, general coding, APC, CPT and HCPCs
- Closely monitoring volumes and performance of charge review work queues, charge edits, and reports while actively seeking opportunity, deficiencies, and improvement strategies
- Supporting best practices for professional services coding and clinical documentation
- Participating in corrective actions in response to variances and trends
- Ensuring that the activities of the professional revenue integrity team are conducted in a manner that is consistent with overall department protocol, Policies and Procedures, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements
- Managing staffing levels and productivity
- Providing team communication regarding department updates, organizational activities, financial performance, educational opportunities, interdepartmental activities, and QI activities
- Ensuring the recruitment, training, and retention of motivated, competent revenue integrity analysts; establishing goals and standards for performance appraisals
- Complying with HIPAA and all relevant laws, rules regulations and accreditation standards and requirements
Requirements
- Previous Revenue Integrity experience preferred
- Experience working for a large healthcare system highly preferred
- Must have Epic experience - prefer a super-user
- Well-rounded and extensive background in Revenue Cycle
- Heavy project management experience
- Extensive data analysis capabilities
- Knowledge of medical coding would be helpful
- Open to candidates with front end business office experience and back end Revenue Cycle experience
- Five (5) years of Physician/Professional Billing experience required
- Three (3) years in a management or supervisory level position for a large health system preferred
- Extensive knowledge and experience with Epic EMR system, specifically with EPIC Resolute Billing with a large health system
- Experience in Charge Capture, Charge Reconciliation, and Charge Pricing
- Comprehensive understanding of healthcare billing and coding systems (e.g., HCPCS, ICD-10)
- Supervisory and mentoring skills necessary to provide support to department and promote employee development
- Advanced proficiency in Microsoft Excel and other Microsoft Business applications (i.e. Word, PowerPoint)
Benefits
- Health insurance
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Revenue IntegrityCharge CaptureCharge ReconciliationCharge PricingMedical CodingData AnalysisProject ManagementHealthcare BillingCPTHCPCS
Soft Skills
Supervisory SkillsMentoring SkillsTeam CommunicationOrganizational SkillsCollaborationProblem SolvingPerformance ManagementEmployee DevelopmentProcess ImprovementCompliance Management