Head of Programme Management

The Program Manager Revenue Integrity offers subject-matter expertise within internal revenue cycle systems to ensure efficient and compliant research patient billing practices across the Service Area of responsibility. This position performs duties of high complexity, judgement, scope, and responsibility with a direct reporting structure to Research Administration and a matrix reporting relationship to the Service Area Revenue Integrity Director to ensure cross-functional integration of accountability across both departments. The Program Manager Revenue Integrity is responsible for the planning and implementation of functional area-based system applications, developing work teams, task delegation, development of policies and work instructions and transactional management of charge review procedures to ensure services are compliant with Federal, State, private payer and other applicable legal and regulatory requirements for research patients.

Additional responsibilities include the ability to build synergistic partnerships with internal/external teams, development and execution of an on-going training program and advanced technical knowledge with various software systems to identify gaps and work towards integration to improve process automation.

Establish collaborative working relationship with research revenue producing departments (Physician Investigators, Research Program Leaders), revenue integrity teams, Optum 360 personnel, information systems personnel, technical and clinical personnel to identify research chargeable activities, establish charge capture mechanisms, and to properly code (or add modifiers) research charges for timely and accurate recording of research claim related revenue consistent with research regulations, state and federal requirements. Make recommendations and take actions to improve structure, system or outcomes.

Education and Training
Development of training plan to educate all stakeholders, including research personnel and coders on necessary chart documentation of research related services to ensure clinical documentation validates research billable charges. Research Charge Management
Development of Research Charge Description Master (CDM) in collaboration with key stakeholders responsible for CDM management. Work includes ongoing additions and management of research protocol items

and services necessary to ensure effective research charge capture in compliance with CMS regulations and other third-party payer policies. Examples include addition of investigational drugs and investigational devices with ongoing maintenance consistent with research protocol contractual periods of performance.

Manage research patient charge revenue cycle beginning with management of Medicare Cost and Coverage Analysis Worksheet (MCCAW) personnel required to translate MCCAW into research patient billing grid to identify billable versus non-billable research charges. Integrate research revenue workflows and needs across preauthorization, registration, charge-capture, charge-review and adjudication teams to ensure compliant claim distribution. Oversee charge reconciliation procedures including research claim holds, movement of charges and quality control methods for release within established timelines. Review research claim denials and develop corrective action plan(s) related to any deficiencies noted concerning research charge capture effectiveness and system integration. Quality Assurance
Develops and implements research Quality Assurance/Quality Control methodologies into operational workflow. Translate findings into action to minimize revenue at risk while identifying research charge trends and audit needs to improve service and ensure regulatory compliance throughout research revenue cycle.

Serve as primary point of contact for all matters related to research revenue integrity with decisional authority to develop and distribute policies, work instructions and procedures necessary for efficient, effective and compliant workflows. Maintains personal professional growth and development through seminars, workshops and professional affiliations. Provides employees access to resources needed to advance subject matter expertise with a synergistic approach to training and process improvement plans.

Identify automation opportunities across software systems such as Cerner EMR, Clinical Trial Management System, Lawson, and various other coding and billing software systems in use within the assigned Service Area. Determines data sources necessary to establish data report information to continually review and recognize clinical research revenue opportunities. Responsibilities include time and attendance, staff training/development and performance management to establish productive, high quality research programs.

Bachelor's degree or a combination ofeducation and/or additional job related experience may be substituted in lieu of the degree., Three years of revenue cycle experience including billing, coding and charge capture and two years of supervisory/management experience., Five years of revenue cycle leadershipa nd/or clinical trial billing experience.

Certified Coding Associate, upon hire or

Certified Coding Specialist, upon hire or

Joseph's Hospital and Medical Center.

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