Hospital Billing - Revenue Integrity Manager - FT - Days - MHS

Manager Of Revenue Integrity

Location: Hollywood, Florida

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary

The Manager of Revenue Integrity is responsible for overseeing the daily operations, performance, configuration, and development of assigned applications to ensure alignment with departmental goals and objectives. This role manages a team of Revenue Integrity Analysts who provide technical expertise to support charge capture processes, system functionality, and compliance requirements. The Manager also designs, implements, and tests controls to optimize revenue capture, enhance net revenue, and ensure regulatory compliance across people, processes, and technology.

Responsibilities

Manages the planning of application development and deployment; educates and promotes adherence to the organization's software compliance standards within the team. Selects opportunities identified by team to implement and improve existing processes using information technology and ensures alignment with strategic initiatives of the organization. Designs and evaluates the tools and processes used to capture charges in each MHS department. Updates the design of tools to empower departmental staff to accurately post charges efficiently, without rework. Designs and implements controls to empower departmental leaders to ensure staff have captured charges accurately and timely. Ensures Epic charge-related work queues are timely and correctly cleared. Utilizes subject matter expert skills to assist MHS leaders with analyses of billing, coding, and documentation requirements for payer coverage and payment of services affecting their service lines and initiatives. Monitors and provides training, support and troubleshooting to both application teams and end-users to facilitate proper usage and continuous learning. Manages applications projects including workflow analysis, end-user validation, acceptance, go-live, and maintenance using standard project management methodology. Sets project deadlines and deliverables for specific modules and analysis. Manages the debugging and enhancements processes including the design and upgrades to existing systems in order to ensure up-to-date and reliable functionality. Periodically tests samples of departmental charges to evaluate whether staff members are performing correctly, and controls are operating as designed. Works with RCM and departmental staff to provide as-needed retraining as well as regular periodic updates for all charge capture staff. Manages and monitors staffing activities including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives. Develops annual CDM CPT/HCPCS updates and implements as approved by the Director of Revenue Integrity. Includes working with operational departments to identify applicable new or revised codes. Oversees the maintenance of CDM-driven CPT/HCPCS coding requirements. Develops annual CDM Fee Schedule updates and implements as approved by the Director of Revenue Integrity. Updates Price Transparency Standard Charges file in accordance with regulatory requirements. Keeps current, timely reads, and analyzes Medicare, Medicaid, and other technical guidance to determine how they affect Memorial Healthcare System (MHS) capture. Develops, recommends, and implements plans to comply with regulatory updates as approved by the Director of Revenue Integrity and in collaboration with responsible MHS leaders. Strategic focus: based on regulatory and industry updates, MHS strategic initiatives, end-user feedback, and other information, identifies and achieves opportunities to improve charge capture efficiency and accuracy, eliminate missed charges, eliminate billing rework, and improve MHS net revenue.

Competencies

ACCOUNTABILITY, ACCURACY, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, DEVELOPS RELATIONSHIPS, EFFECTIVE COMMUNICATION, ORGANIZATION SKILLS, PRODUCTIVITY, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR, TEAM WORK

Education and Certification Requirements

Associates (Required)Epic Charge Router Certification (EPIC CHG ROUTER) - EPIC Certification (EPIC), Epic Resolute Billing Certification (EPIC BILLING) - EPIC Certification (EPIC)

Additional Job Information

Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment, and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Required Work Experience: Minimum of five (5) years' Epic charge master (preferred) and/or billing experience. Able to build charge records (EAP) and controls (charge router, charge handler, and revenue guardian). Minimum of three (3) years' experience of supervising/managing a team. Other Information: Additional Education Info: Associate's degree required; Bachelor's preferredCertification Requirements:Epic Resolute Billing CertificationEpic Charge Router CertificationCandidate must have or be pursuing a coding credential (AHIMA or AAPC) which must be obtained within a year of taking the position.

Working Conditions and Physical Requirements

• Bending and Stooping = 40%
• Climbing = 20%
• Keyboard Entry = 60%
• Kneeling = 40%
• Lifting/Carrying Patients 35 Pounds or Greater = 20%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 40%
• Lifting or Carrying > 75 lbs Non-Patient = 20%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 40%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 40%
• Pushing or Pulling > 75 lbs Non-Patient = 20%
• Reaching = 40%
• Repetitive Movement Foot/Leg = 0%
• Repetitive Movement Hand/Arm = 60%
• Running = 0%
• Sitting = 60%
• Squatting = 40%
• Standing = 60%
• Walking = 60%
• Audible Speech = 60%
• Hearing Acuity = 60%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 60%
• Distinguish Color = 60%
• Seeing - Far = 60%
• Seeing - Near = 60%
• Bio hazardous Waste = 20%
• Biological Hazards - Respiratory = 20%
• Biological Hazards - Skin or Ingestion = 20%
• Blood and/or Bodily Fluids = 20%
• Communicable Diseases and/or Pathogens = 20%
• Asbestos = 0%
• Cytotoxic Chemicals = 20%
• Dust = 60%
• Gas/Vapors/Fumes = 20%
• Hazardous Chemicals = 20%
• Hazardous Medication = 20%
• Latex = 20%
• Computer Monitor = 60%
• Domestic Animals = 20%
• Extreme Heat/Cold = 0%
• Fire Risk = 0%
• Hazardous Noise = 20%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 20%
• Magnetic Fields = 20%
• Moving Mechanical Parts = 20%
• Needles/Sharp Objects = 0%
• Potential Electric Shock = 20%
• Potential for Physical Assault = 0%
• Radiation = 20%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 20%

Shift: Primarily for office workers - not eligible for shift differential

Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.Memorial Healthcare System recruits, hires