Revenue Integrity Manager

Statement of Purpose: This position ensures compliance with all regulations, policies, and procedures related to medical billing. The Revenue Integrity Manager reviews systems and processes to identify potential compliance issues, works with appropriate departments to correct such issues, serves as the internal resource for billing-related questions, provides training related to appropriate billing, and works with various departments to ensure billing compliance. In addition, the Revenue Integrity Manager will be responsible for implementing short and long-term plans and objectives to improve billing, coding, denials/rejections, and appeal processes.

CAN Values:

1. Recognize and affirm the unique and intrinsic worth of each individual.
2. Treat all those we serve with compassion and kindness.
3. Act with absolute honesty, integrity, and fairness in the way I conduct my business and the way I live my life.
4. Trust my colleagues as valuable members of our healthcare team and pledge to treat one another with loyalty, respect, and dignity.

Essential Functions:

1. Promotes and practices CAN Community Health Inc’s mission and values and follows its policies and procedures.
2. Ensures confidentiality is maintained by entire team regarding patient/client information in accordance with HIPAA, professional and departmental standards.

Primary Tasks:

1. Manage and optimize the revenue cycle process, ensuring accurate and timely billing, coding, and reimbursement.
2. Ensure compliance with regulatory requirements, coding guidelines, and billing practices (such as HIPAA, CMS regulations, etc.).
3. Conduct analysis of revenue data, identify trends, and generate reports to support decision-making and improve revenue capture.
4. Implement strategies to enhance revenue capture, reduce denials, and improve overall revenue cycle efficiency.
5. Oversee charge capture processes, ensuring completeness and accuracy in coding and billing procedures.
6. Work closely with coding, billing, finance, and clinical teams to resolve revenue-related issues and streamline processes.
7. Provide guidance, training, and education to staff on revenue cycle best practices, coding updates, and compliance issues.
8. Conduct regular audits to ensure billing and coding accuracy, identify areas for improvement, and mitigate compliance risks.
9. Demonstrate a high level of commitment to customer service in responding timely to the needs of internal and external parties or departments. 
10. Monitors benchmarks and KPIs and uses actionable data for improvement.
11. Provide daily management and support to team to ensure they are working effectively and correctly completing assigned tasks. 
12. Functions as a working manager as necessary to facilitate trainings, improvements, project work, and revenue cycle optimization.
13. Supervises, interviews, hires staff, trains new personnel, conducts performance appraisals; promotions, dismissals, PTO requests, and approves payroll.

Secondary Tasks:

1. Practice Integrity and Mission and Value statement. 
2. Communicates effectively and collaborates with other departments to implement regulatory standards that assist in revenue attainment while accurately complying with billing guidelines.
3. Develops and manages revenue process improvement strategies in support of clinical departments, implementation of information systems, and process initiatives. 
4. Responsible for maintaining system edits to ensure they achieve compliance, payment optimization, and process efficiency. 
5. Responsible for the implementation of the annual fee schedule changes.
6. Communicates annual coding/fee schedule changes across the organization.
7. Leads projects with efficiency, project plans, and status reports.
8. Strong communication and interpersonal skills and the ability to work effectively with a diverse population.
9. Sites visits as necessary.

Physical Requirements:

1. Requires frequent bending, stooping, and standing. Requires visual and auditory acuity, frequent sitting and walking for extended periods of time.

Education/Professional:

1. Bachelor’s degree in healthcare, Business, Finance, or more than 5 years equivalent healthcare experience
2. Five+ years management experience in a healthcare setting. 

Competencies:

1. Leadership
2. Strategic Thinking
3. Problem Solving
4. Results Driven
5. Communication
6. Interpersonal Skills
7. Decision Making
8. Customer Service

Knowledge, Skills and Abilities Required:

1. Ability to work with minimal supervision.
2. Strong coaching and development skills with the ability to organize activities for a productive team and lead effectively with time and project management skills.
3. Ability to research projects using primary sources when appropriate, such as CMS, HRSA, AHCA, etc.
4. Experience working with medical payers including Medicare, Medicaid, Commercial and third-party administrators.
5. Strong problem-solving skills with the ability to research complex information, create insights, communicate recommendations, and implement appropriate solutions.
6. Knowledge of insurance procedures, reimbursement guidelines, and claim filing processes.
7. Excellent organizational, interpersonal, and communication skills.
8. Able to regularly review productivity and make staffing adjustments as needed.
9. High comfort working in a diverse environment.
10. Ability to effectively communicate both written and verbally.
11. Ability to effectively utilize problem-solving and decision-making techniques.
12. Ability to make effective judgments and decisions based on objective criteria.
13. Strong work ethic
14. Demonstrated leadership abilities, including team building and collaboration.
15. Excellent Computer skills and proficiency in Microsoft Office (EXCEL, VISIO, Word, PowerPoint)

CAN Required Trainings:

General Orientation Violence in the Workplace

HIPAA Sexual Harassment

HIV/AIDS Health Stream Courses as assigned

Work Environment:

This job operates in a professional office environment or may be remote. This role routinely uses standard office equipment such as computers, audio visual, telephones, photocopiers, filing cabinets and fax machines.

Position Type/Expected Hours of Work:

This position may require additional time above normal operating hours and on occasion weekend work.

Travel:

When/If necessary, travel is primary during the business day, although some out-of-area and overnight travel may be expected. Must be able to operate a motor vehicle and have valid insurance and driver’s license.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of an employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. 

Responsible To: Sr. Revenue Cycle Manager