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The Manager, Compliance and Revenue Integrity (CRI) manages one or more functions within the Compliance and Revenue Integrity organization. They are responsible for the strategic and operational oversight of their assigned function(s) including overseeing staff, developing policies, procedures, and workflows to ensure maximum efficiency and accuracy. They are also responsible for data integrity and provide strategic analysis of data/reports, conveying findings and making recommendations to senior leadership.??

• Areas of assigned responsibility may include managing the processes for charge capture, charge reconciliation, charge maintenance, pricing strategy, CDM/fee schedules (hospital and professional fee/clinic pricing), charge tickets creation and maintenance, charge edits, clinical denials, revenue-related audits, revenue cycle regulatory monitoring and compliance, and multidisciplinary clinical, operational, and financial revenue practice teams.??
• Responsible for evaluating finalized claims, adjustments, complex customer concerns, and audits to identify and track issues related to billing, coding, system functionality, clinical documentation, and regulatory needs.
• Develops and reports out on findings for different quality reviews and helps not only to identify common issues but make recommendations on appropriate steps for remediation.
• Monitors process improvements related to compliance and revenue opportunities and takes a leadership role in informing partners and providing solutions.
• Serves as a subject matter expert and will be called upon to provide opinion and guidance on issues related to coding, billing, and operational compliance.
• Manages, coordinates, and champions multiple revenue cycle initiatives across the organization (PB/HB) to improve processes and support optimal high-performing revenue cycle operations.
• Oversight of the team managing the Medicare and Medicaid RACs, government billed claims and inpatient stay reviews, and commercial payer audit and recovery programs. Communicates trends and presents executive updates to Compliance, Utilization Review, and Finance leadership. Partners with internal counsel and external vendors during all levels of the appeal process including settlement conferences and trials. Maintains and monitors high success rates in the audit program.
• Provides reporting and feedback to Revenue Cycle and clinical operations collaborators to support correct and compliant documentation, coding, charge capture and billing across the system for all hospital and professional services patient accounts and locations.
• This role partners with departments to reduce revenue leakage through impact studies, revenue reviews, and industry best practice.??
• May manage assigned teams for the optimization of net revenues.??
• Responsible and accountable for implementing revenue capture strategies and ensuring efficient and compliant revenue processes which ensure that the organization collects all revenue to which it is entitled while maintaining compliance.

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Requirements:

• Bachelor's degree in business, economics health or a related major required.??
• Coding or health care compliance certifications and Epic certifications preferred.??
• A minimum of 5 years of experience in revenue cycle, revenue integrity or billing experience in a hospital based or medical office setting required.
• 5 years or more of proven experience in revenue cycle, revenue integrity or billing experience in multi-specialty medical group or medical office setting preferred.
• Management and supervisory experience preferred.

Why work here?

Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) we take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation.