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Manager, Quality – Revenue Integrity
Ovation HealthcareManager of Quality Assurance & Revenue Integrity overseeing hospital revenue cycle processes and ensuring compliance and optimization. Collaborates with clinical, coding, billing, and finance teams.
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- Remote role 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score
ATS Keywords
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Hard Skills & Tools
codingbillingauditingreimbursementcharge captureICD-10CPTPCSHCPCSModifiers
Soft Skills
collaborationeducationanalysisleadershipcommunication
Certifications
RHIARHITCCSCPCCHC