Manager, Revenue Integrity

Revenue Cycle Manager

POSITION PURPOSE Provides support and day-to-day operational management for the Medical Group and Provider Services (MGPS) Revenue Cycle operations; including registration, insurance verification, POS collections, authorizations, charge capture and charge controls, revenue integrity and optimization, coding and general practice revenue cycle operations. May have oversight for payer enrollment and credentialing and other practice related functions. Manages the strategic focus of operational excellence through central oversight and management of revenue cycle practices across the region to ensure standardization, implementation and utilization of top decile practices. Serves as a key change leader. Works closely and collaborates with Regional CFOs, Patient Business Service (PBS) center, C-Suite, Payer Strategies, MGPS Practice Leaders, Hospital Site Operations leaders and other leaders and colleagues across the organization. Incumbent reports to Regional Director or Director of MGPS Site Operations or will have an A2 relationship to both the Vice President of MGPS RC Site Operations and the Regional or Local Finance leader.

ESSENTIAL FUNCTIONS

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions
• Manages Medical Group revenue cycle operations for the region, including proper implementation of system and local goals to ensure standard and top decile operations.
• Manages the implementation of current and future best practices for revenue cycle functions to allow all practices to be efficient and market relevant, including overseeing the implementation and monitoring of adherence to payer contracts and procedures. Provides effective use of system resources to drive optimal revenue cycle outcomes.
• Responsible for establishing partnerships with senior leadership at the RHMs, MGPS Finance leaders, Payer Strategies and PBS Leaders to gain feedback, develop, and implement action plans to improve front-end Revenue Cycle processes that have a direct impact on billing and collections for account resolution.
• Manages the selection, direction, and development of new team members to ensure effective growth and utilization of talent. Conducts performance appraisals for team leadership and oversees the cascading goals for the teams. Creates a culture that is supportive of personnel, fostering individual motivation, teamwork and high level of performance and accountability utilizing a participative management style to ensure colleague retention.
• Manages in the selection and facilitation of appropriate process and technology training of colleagues to achieve technical proficiency, efficiency, regulatory compliance, and customer service in Revenue Cycle areas.
• Manages regional budgets and targets allowing for financial oversight of the regional Revenue Cycle department functions.
• Collaborates with MGPS senior leadership and Finance leaders, Practice leaders, PBS leaders, regional directors, regional clinical leadership, and colleagues to accomplish key performance goals, implement performance improvement via A-3 projects and other strategic initiatives, and identify opportunities for improvement through the integration of people, process, and technology.
• Collaborates with Hospital Site Operations, Vice President of MGPS RC Site Operations and the Regional or Local Finance Leader to direct and lead local Revenue Cycle and oversee the professional Revenue Integrity functions, including but not limited to: Charge Description Master (CDM), Pre-bill edits assigned to Revenue Integrity, complex coordination and denial prevention.
• Accountable for key revenue cycle outcomes based on RHM performance, in collaboration with local site leadership, PBS leadership, and System Office leadership, including but not limited to: Financial secure rate (Insurance Verification), Authorization rate, Upfront collections, Denial rate, Colleague quality and productivity, Colleague Engagement and Satisfaction related to Revenue Cycle, Patient Engagement and Satisfaction, FY Budget Targets
• Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior.

MINIMUM QUALIFICATIONS

• Must possess a comprehensive knowledge of physician practice revenue cycle operations, revenue metrics and analytics, and revenue management, as normally obtained through a Bachelor's degree in business or Healthcare administration or a related field, and five (5) to seven (7) years of revenue cycle operations, revenue metrics and analytics, and revenue management experience or an equivalent combination of education and experience.
• Minimum of three (3) years of management experience in a multi-facility, integrated health care delivery system or revenue cycle or consulting experience.
• Knowledge of revenue cycle and accounting systems and insurance issues, healthcare industry issues and trends, legal issues in field of expertise, required third party and governmental guidelines, and work processing. Epic experience strongly preferred.
• Exhibits strong leadership, integration and execution skills with considerable experience in planning, formulating, and execution strategies with the ability to define program, process, or business objectives and scope, while also demonstrating proficiency and expertise to identify, evaluate and articulate operational opportunities, and risks, business needs/gaps, and understand customer/stakeholder interests.
• Demonstrates advanced analytical, evaluative, problem solving and decision-making skills to serve in managerial role in inspiring and initiating new ideas, determining strategies in the absence of guidelines, fostering innovative approaches to situations/processes/issues and executing multiple critical assignments.
• Possesses excellent written and verbal communication skills to effectively identify, assess and facilitate improvements and resolution to present advisory, persuasive and authoritative recommendation to all levels.
• Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel.
• Maintains professional development and growth through journals, professional affiliations, seminars, and workshops to keep abreast of trends in revenue cycle operations and healthcare in general: Participates as appropriate in continuing educational programs and activities that pertain to healthcare and revenue cycle management, as well as specific functional areas; Develops and implements an annual plan of personal and professional development; Participates in local, regional and national health care revenue activities and professionally represents Trinity Health at these functions.
• Serves in a leadership role and promotes positive Human Resource Management skills: Fosters teamwork atmosphere between business and clinical stakeholders; Retains, recruits and manages staff to achieve strategic objectives; and Provides staff training and mentoring.
• Must be able to travel approximately 25% of the time as may be needed in the region. This may include travel to MGPS locations outside of the Region and to System Office as may be necessary.
• Must be comfortable operating in a collaborative, shared leadership environment.
• Must possess a personal presence that is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health.

LEADERSHIP COMPETENCIES As a Trinity Health Executive, the incumbent is expected to demonstrate leadership traits, which support our Mission Statement and Core Values as identified below:

Mission Statement: We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Core Values:

• Reverence: We honor the sacredness and dignity of every person.
• Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable.
• Justice: We foster right relationships to promote the common good, including sustainability of Earth.
• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.
• Integrity: We are faithful to those we say we are.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

• This position operates in a typical office environment. The area is well lit, temperature controlled and free from hazards.
• Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.
• Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication.
• The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.
• Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
• Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities.
• Must be able to travel approximately 25% of the time as may be needed in the region. This may include travel to MGPS locations outside of the Region and to System Office as may be necessary.
• Must possess the ability to comply with Trinity Health policies and procedures.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.

St. Joseph's College of Nursing