Revenue Integrity Manager

The Revenue Integrity Manager will lead the development of the revenue integrity function and is responsible for the oversight and management of the revenue integrity team. This position is accountable for optimizing revenue by ensuring accurate, compliant, and efficient charge capture and billing practice. The Revenue Integrity Manager will improve the performance of revenue cycle processes including developing best practices, coordinating issue resolution, establishing proactive lost revenue prevention measures, and monitoring compliance. The ideal candidate has a strong understanding of EPIC systems, coding standards, and billing regulations across both physician and facility revenue streams.

• Utilize data analytics and process improvement techniques to identify potential revenue leakage and support accurate charge capture. Use EPIC reporting tools to extract and analyze charge data. Perform extensive data mining, develop reports, review trends, and recommend enhancements to resolve lost revenue.
• Manage a team of chart reviewers.  Design and implement a chart review program   to ensure completeness of records, appropriateness of billing, and compliance with regulatory and payer requirements.
• Identify coding and documentation discrepancies to provide recommendations. Monitor for positive or negative trends in coding, charge capture and/or editing processes. Analyze denial trends related to charge capture and billing. Collaborate with coding, billing, and clinical teams to identify root causes and implement corrective actions.
• Maintain documentation of audit findings, trends, and resolutions to support compliance and training efforts. Measure key performance indicators (KPIs).  Prepare reports and present findings and recommendations to management.
• Oversee and maintain the CDM, identifying opportunities for missed revenue. Including an annual comparison of Prevea’s CDM and supply/implant costs to payer contracts. Develop and maintain all retail pricing.  Participate in service line pricing reviews.
• Research and stay current on CMS, federal and state regulations, payor guidelines, ensuring compliance and alignment with charge, coding and charge edits.  Complete analysis of revenue impacts as a result of CMS payment changes.
• Performs full range of managerial responsibilities which may include but not be limited to interviewing, hiring, coaching and developing employees; planning, assigning and directing work. Encourage innovation, teamwork, fiscal responsibility, and high-quality work.