Manager, Revenue Integrity
Company: Alameda Health System
Posted on: November 19, 2021
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
Develops and communicates system level leadership reports on gross
department revenues and other needed revenue cycle/integrity
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
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
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, &
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
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
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
Serves as a resource to hospital departments for implementation or
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
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
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
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
Keywords: Alameda Health System, Oakland , Manager, Revenue Integrity, Executive , Oakland, California
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