Under the direction of the Revenue Integrity Director, the Revenue Integrity Senior Manager will provide operational oversight of the Revenue Integrity Analyst team. Responsibilities include revenue optimization through implementing standard charge capture reconciliation, charge capture review initiatives, charge capture education and process to ensure charge capture integrity and revenue optimization in compliance with CMS and other regulatory agencies.
Monitors and trends financial data related to charge capture progress toward revenue cycle goals, identifies variances and implements process improvement as necessary to enhance compliant revenue optimization.
Provide operational oversight of the revenue integrity staff and serve as a liaison between Revenue Integrity and clinical/operational departments to escalate charge issues and inquiries to key stakeholders. Supports finance, operations, and revenue cycle teams through special projects.
Develop, educate and manage Revenue Integrity Specialists, supporting them in analyzing, communicating and educating hospital and clinics regarding deficient charging trends and corrective action plans to resolve deficiencies.
Engage with clinical areas and revenue cycle departments across Banner to confirm billable items and services are charged appropriately and in a timely manner.
Provide revenue integrity recommendations and updates to the Revenue Integrity Steering Committee with potential actions for remediation. Upon resolution and approval of recommendations confirm appropriate actions are carried out accurately and completely.
Maintains current knowledge of regulatory changes impacting charge practices. Develops charge capture and reconciliation policy and procedures. Monitor/report monthly KPI Revenue integrity metrics dashboard.
Implement charge capture review program for hospital revenue generating departments. Coordinates processes between operations and revenue cycle departments ensuring that the accounts reviewed reflect proper documentation, charge capture, coding and billing to support proper payment.
Manages charge reviews to ensure annual coding changes/new service lines incorporated into charge master flow correctly to the patient bill. Purpose of these special projects are department specific and the goal is to identify potential compliance issues and revenue leakage issues.
Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelors degree in business, health care administration or related field.
In the acute care environment, requires a Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT) or Certified Coding Specialist (CCS) in an active status with American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC). In the ambulatory setting, requires Certified Professional Coder (CPC) certification or Certified Coding Specialist-Physician (CCS-P), with RHIA, RHIT or CCS certification preferred.
Requires proficiency typically obtained with five or more years of health care coding and billing experience. Must possess a thorough knowledge of ICD/DRG coding and/or CPT coding principles, and the recommended American Health Information Management Association coding competencies. Requires an in-depth knowledge of medical terminology, anatomy and physiology, plus a thorough understanding of the content of the clinical record and an extensive knowledge of all coding conventions and reimbursement guidelines, across all services lines, LCD/NCDs and MAC/FIs. Extensive critical and analytical thinking skills required. Ability to organize workload to meet deadlines and maintain confidentiality of all work information. Ability to research, interpret and develop recommendations. Excellent written and oral communication skills are required, as well as effective human relations and leadership skills for building and maintaining a working relationship with all levels of staff, physicians, and other contacts.
Additional related education and/or experience preferred.
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.