Revenue Integrity Senior Manager

Job Description:

The Revenue Integrity Senior Manager is responsible for the strategic leadership and direction supporting initiatives preventing revenue leakage, accelerating cash flow, and maximizing reimbursement of services by evaluating the strategy, operations, and performance of the following functional areas: Professional/Facility Charge Capture, EPIC All Procedure(EAP), Strategic Pricing, Pricing Transparency, Denials Management, Reporting and Analytics.

Education Qualifications:

Key Responsibilities:

• Oversees process improvement efforts to support compliance and to optimize net revenue within the functional areas of Revenue Integrity, and Revenue Services Analytics including:
• Chargemaster - EPIC All Procedure (EAP) – Oversees the EPIC All Procedure (EAP) Master is maintained, compliant and new codes are entered timely, priced appropriately, and any pre-bill edits are worked timely
• Strategic Pricing – Oversees and provides direction into system-wide annual pricing models and ad hoc pricing changes and presents impact to senior leadership
• Pricing Transparency – Defines, develops, and leads the pricing transparency efforts with multiple departments to ensure the Essentia Health website files, and pricing posters are fully compliant with pricing transparency regulations
• Denial Management – Oversees and provides system direction into Denial Management strategies, and presents results to senior leadership
• Revenue Services Analytics – Collaborates with Revenue Services Analytics Manager and Enterprise Analytics Manager to ensure cross-training opportunities are maximized to support data requests

• Identifies trends across functional areas and coordinates integrated collaboration and issues resolution initiatives
• Negotiates vendor contracts and monitors performance to ensure contract terms are being met
• Identifies opportunities for system or process improvements and drive change through targeted initiatives
• Manages and oversees Revenue Integrity Department work, provides technical, specialized leadership and guidance in coordinating projects and managing deliverables, and serve as a resource for ad-hoc problem resolution and troubleshooting
• Commits to team development, communication, and quality improvement throughout Revenue Integrity and Revenue Services Analytics

Educational Requirements:

• Bachelor’s degree required with a preference in Healthcare Administration, or other related field of study

Required Qualifications:

• 5 years hospital revenue cycle or reimbursement experience including seven 3 years Management experience supporting data management and data analysis, Revenue Services workflows, payer reimbursement, and claim coding, strong understanding of medical terminology