Manager, Revenue Integrity

Company: Alameda Health System
Location: Oakland
Posted on: November 19, 2021

Job Description:

Summary

Alameda Health System is hiring!The Manager of Revenue Integrity is responsible for oversight of the Charge Description Master (CDM) for Hospital and Professional services, assuring compliance and integrity of the CDM content, which require routine/annual maintenance of codes, prices, and developing and analyzing related reports. Actively monitors all work queues assigned to the Revenue Integrity team and those owned by clinical or technical teams to assure timely and accurate charge capture to prevent delays with claim submission and claim denials. Partners with Revenue Cycle, Clinical, and Information Services (IS) teams to assure accuracy of charging workflows and resulting claim content. Additionally, the Revenue Integrity Manager serves as the Charging Subject-Matter Expert for remediation and optimization projects.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE : The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

Collaborates with the various business units to verify adherence to charge posting policies and procedures, ensuring compliance with required governmental laws, regulations, contractual requirements, standards, and practices both related to the systems charge master and charge posting.

Coordinates meetings with department managers, staff and/or physicians regarding new program and procedure developments, equipment acquisitions and validation of charging codes. Determines charge, charge attributes (e.g., when, and how a charge is triggered, charge routing, etc.), and charging workflow for services and products and ensures the developing of the charge master items to include pricing (For Professional and Hospital Claims).

Develops and communicates system level leadership reports on gross department revenues and other needed revenue cycle/integrity reports.

Establishes and performs periodic billing/claim reviews based on CDM complexity and Risk.

Identifies charging/billing opportunities (e.g., reimbursable items not being charged, etc.) necessary for accurate reimbursement.

Identifies opportunities (e.g., reimbursable items not being charged, etc.) for charge capture and reimbursement improvement using contract and denials management tools/techniques, random reviews (including payment accuracy reviews), review of medical records and claims data.

Keeps abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices by reviewing Federal Register, fraud alerts, OIG advisory opinions and other relevant publications. Communicate changes to impacted leaders and provides education on such changes.

Keeps abreast of payer and billing, collection, and general coding requirements; applies knowledge to review that charges are accurate, billed correctly and supportable according to payor requirements. Researching and resolving CPT and HCPCS codes, revenue codes, and other issues as needed to support charging and billing requirements.

Maintains the CDM by incorporating new charges/services identified by the departments, third-party changes, CMS regulations, federal and state specific coding updates. Also, by the over site of Canewares Compliance modules with ensuring that they are always up to date

Manages assigned work queues/work lists/reports pertaining to missing charges or incorrect charges and the edit resolution.

Manages daily work queue processes related to assigned edits to build effective resolutions and timely claim processing.

Monitor and review that Epic Charging Work queue are current and partners with responsible stakeholders to track resolution of coding/billing edits in Epic within set deadlines, supporting compliant charge capture practices, support claims timely filing, & reduce denials.

Monitors and resolves billing errors resulting from coding discrepancies are efficiently investigated and validated, providing proper feedback to physicians, staff and/or department Leads.

Monitors daily reconciliation dashboard and or reports (e.g., missing charges reports, late charges, etc.) that assist managers in maintaining accurate and timely charges. Implements a process that reconciles charges back to the daily facility procedures, ancillary and clinic patient schedules.

Monitors WQ Edits, Communicating edits and changes to the clinical departments and administration, revenue cycle, and others who are impacted by the change.

Monitors, tracks, and the performance of routine reviews to ensure that charging workflows, are working properly for all charging scenarios at AHS.

Oversee the daily operations of Revenue Integrity staff and all Work queues (Account, Charge Review, Charge Router, and Claim Work queues) the Department is directly responsible for clearing daily.

Performs a detailed, annual review of the CDM that includes identifying CPT and HCPCS codes that have been deleted, added, or replaced; assigns CPT and HCPCS specific codes when appropriate, identifies description changes, create the nomenclature which reflects the procedures performed, and maintains an audit trail of all changes.

Responds to outside compliance questions, complaints, and inquiries related to Charging, Coding, CDM and Denial Items.

Responsible for over site of the Charging Integrated Work Group Meetings and agenda, identifies opportunities to improve net revenues through charge structure and capture, and system optimization.

Serves as a resource to hospital departments for implementation or regulatory questions.

Supports and maintains charge capture and entry systems and processes for all points of revenue capture at Alameda Health System to review that all (facility and professional fee) charges and codes are reconciled daily and meet system charge lag targets. Includes coordination with practice managers/directors to develop and implement policies and procedures for purposes of reconciling charges posted in the billing system.

The position requires excellent knowledge of ICD10, CPT/HCPCS and revenue codes, CMS billing regulations and healthcare reimbursement and reviews the charges, revenues and billing related to facility and physician practices are current, accurate, and compliant with rules and regulations specific to each payor group on an ongoing basis.

Works with department managers/staff on charge capture workflows, work queues/work lists in addition to proper documentation and coding to support accurate and compliant charging and or new charge capture workflows supporting organizational initiatives.

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

MINIMUM QUALIFICATIONS:

Preferred Licenses/Certifications: Epic certification

Required Education: Bachelor's degree in healthcare administration, finance, business administration or related field, OR Eight years-- experience in healthcare related revenue cycle functions, including coding and billing guidelines may be substituted for a Bachelor--s degree.

Required Experience: Five years of experience with two years supervisory experience in healthcare CDM maintenance, charging practices, coding, billing, collections, and/pr denials in a hospital/ambulatory setting AND a minimum of 1 year of hands-on experience with Epic.

Required Licenses/Certifications: Valid Certified Coder Certification (i.e., CPC, CCS, CPC-H or CIC- Certified Inpatient Coder) from an accredited national institution such as AHIMA and AAPC.

Finance
Revenue Integrity
Full Time
Day
Management
FTE: 1

Keywords: Alameda Health System, Oakland , Manager, Revenue Integrity, Executive , Oakland, California