Revenue Integrity Manager - San Mateo Medical Center (Open & Promotional)

Revenue Integrity Manager - San Mateo Medical Center

At San Mateo County Health, we lead by example. From our most seasoned professionals to our newest team members, everyone has the opportunity to step forward to offer their insight, opinions and ideas. As part of our hospital, you'll have the chance to explore new avenues for growth while you meet the diverse healthcare needs of a thriving, vibrant community. San Mateo County Health is located is 25 minutes South of San Francisco, 25 minutes North of San Jose and 25 minutes from beautiful Half Moon Bay! The basis of revenue integrity at San Mateo Medical Center (SMMC) is to prevent recurrence of issues that can cause revenue leakage and/or compliance risks through effective, efficient, replicable processes and internal controls across the continuum of patient care.

The ideal candidate for this position will have:

• Broad understanding of the healthcare revenue cycle, demonstrated by process improvement initiatives that led to quantitative improvements in revenue cycle performance and key performance indicators.
• Broad understanding of Medicare and Medicaid (Medi-Cal) regulations and programs demonstrated with a history of working in organizations with revenue sources from Medicare and Medi-Cal.
• Strong analytical thinking, attention to detail, effective communication, and problem-solving abilities.
• Bachelor's degree in Business, Finance or Healthcare Administration, Master's degree preferred.
• Seven (7) years of progressive experience in medical billing or revenue cycle operations, including five or more in a leadership role at a hospital or healthcare environment.
• Advanced leadership, coaching, and team development skills.
• Strong written and oral communication and collaboration skills with the ability to partner across functions and departments.
• Proficiency in EHR systems (e.g., EPIC)
• HFMA Certified Revenue Cycle Representative.

Responsibilities include:

• Manage the Charge Description Master to ensure inclusion of all billable service codes. Support and facilitate the annual charge description master (CDM) pricing review in alignment with finance and reimbursement policies and guidelines.
• Maintain, review, and revise internal policies, and procedures related to revenue integrity. Communicate and ensure training for such policies and procedures to stakeholders.
• Ensure the effectiveness of the revenue integrity program, including overall consistency and integration of integrity activities throughout the organization.
• Work closely with the CFO and Compliance Officer to ensure that the revenue integrity program meets applicable financial, operational, and legal requirements. Monitor and assess integrity risks and ensure that the revenue integrity program is responsive to those risks.
• Develop key performance indicators for revenue integrity and define targets based on industry standards. Track metrics and report on no less than a monthly basis to the CFO, Revenue Cycle Excellence Committee, and Executive Management Team. Identify barriers to meeting targets and lead related performance improvement activities.
• Perform ongoing monitoring of charge capture patterns, including late charges, charge reconciliation, coding conflicts and charge related denials, to identify and prioritize areas for optimization.
• Partner with clinical departments to support timely and accurate charge capture. Drive communication of CDM changes to impacted clinical departments
• Support clinical departments related to new revenue initiatives, serve as the subject matter expert in the development of new CDMs to support the new clinical service offering.
• Oversee monitoring of bulletins from the Centers for Medicare & Medicaid Services, Medi-Cal and other payors. Assess the impact of such bulletins and coordinate with revenue cycle managers to implement changes driven by such informational bulletins; ensure the action plans are implemented accurately and in a timely manner.
• Consult with the Compliance Officer as needed and serve as liaison to revenue cycle, supporting auditing, data and analytics requests.
• Facilitate revenue cycle participation in compliance audits and investigations, plan and execute internal compliance reviews, audits and activities, and conduct routine internal audits of department revenue capture.
• Serve as an internal resource for billing-related questions, provide training related to charge capture, and work with various departments to help ensure billing compliance.
• Collaborate with other department managers on relevant aspects of assigned program area; discuss organization problems, develop alternatives strategies for dealing with those problems; assist in implementation of solutions, as necessary.
• Direct, mentor and evaluate staff. Ensure staff members are knowledgeable about revenue assurance needs and reimbursement issues identified through audits, reviews, and aggregate data analysis.
• Oversee the management of EPIC work queues, identify automation opportunities, and partner with Health Information Technology to address updates or changes needed to optimize revenue cycle performance.
• Perform related duties as assigned.