Job Summary: 

• Directs daily activities of revenue integrity areas for all hospital and physician organization billing, providing direction regarding the department’s priorities and standards
• Directs the development, implementation, and maintenance of revenue integrity policies and procedures.
• Ensures compliance with all government regulations. 
• Promotes compliance with established departmental policies for attendance, punctuality, procedures and safety. 
• Complies with organizational policies and procedures.
• Ensures the identification of revenue cycle infrastructure and operational issues, as relate to workflow processes, charge entry, and coding across high-volume and/or high revenue-generating clinical departments, as well as the identification of any corresponding bottlenecks, charge lag delays, denials, backlogs, and rework activities.
• Ensures the research/analysis of data to resolve operational issues, identify and select alternatives to address outstanding issues, and implement solutions for improvement.
• Ensures the collaboration of the Revenue Integrity team with data analysts, physicians, and leadership to educate and train providers and staff about appropriate charge capture, coding, and documentation.
• Ensures proper oversight and management of changes/updates to the charge description master to maximize reimbursement 
• Establishes and maintains a clear feedback loop and communication structure across CDM stakeholders to promote transparency and accountability.
• Ensures the review and recommendation of changes, as appropriate, to department organizational structure, charge capture methods, and tools to facilitate accurate and comprehensive billing and compliance.
• Ensures all clinical activity is being captured, coded, and recorded timely in the appropriate financial application(s).

Skills on Resume: 

• Revenue Integrity Management (Hard Skills)  
• Policy Development (Hard Skills)  
• Regulatory Compliance (Hard Skills)  
• Operational Analysis (Hard Skills)  
• Problem Resolution (Hard Skills)  
• Educational Training (Hard Skills)  
• Stakeholder Communication (Soft Skills)  
• Process Improvement (Hard Skills)  

Job Summary: 

• Facilitates the completion of detailed audits of inpatient and/or outpatient medical accounts, assessing the accuracy of documentation to support claims/reimbursement, as well as the reporting of charge errors, as appropriate, to patient financial services, payers, and patients.
• Oversees enterprise charge capture processes, productivity of auditors, prospective/retrospective clinical documentation audits to support billing/reimbursement, education/training, and monitoring of clinical department charge capture functions.
• Facilitates identification of issues and trends leading to claim denials and avoidable write-offs.
• Ensures the research and analysis of accounts to determine the root cause of those issues.
• Facilitates initiation of action plans for identified denial issues, payment delays, and avoidable write-offs.
• Prioritizes the resolution of denials/write-offs trends that most affect cash collections.
• Leverages cross-departmental communication, collaboration, and engagement in order to resolve denials/write-offs issues, and facilitates the execution of action plans to address process breakdowns.
• Ensures each department reviews population of denials/write-offs root cause categories on a monthly basis and completes any assigned action items that arise.
• Ensures the coordination of revenue management orientation and educational activities of clinical personnel including providers and staff - about coding and other outstanding revenue cycle issues.
• Develops and enforces productivity standards and performance goals, and monitors department’s performance.
• Maintains regular contact with staff to keep abreast of issues and to provide feedback on overall operations and specific issues.
• Assumes responsibility for professional growth and development of all Revenue Integrity staff.

Skills on Resume: 

• Audit Facilitation (Hard Skills)  
• Charge Capture Oversight (Hard Skills)  
• Trend Analysis (Hard Skills)  
• Root Cause Analysis (Hard Skills)  
• Action Planning (Hard Skills)  
• Cross-departmental Collaboration (Soft Skills)  
• Revenue Management Education (Hard Skills)  
• Performance Monitoring (Hard Skills)  

Job Summary: 

• Ensure all patient charges are accurate and fully charged.
• Lead team to perform detailed chart reviews and update chart to include any missed charges.
• Deploy, monitor and upgrade analytic tools and processes.
• Direct use of outside consultants including contract negotiations and third party billing.
• Oversee development, monitoring and compliance of departmental budget(s).
• Support accounts receivable and revenue valuation quarterly reviews performed by auditors.
• Develop revenue valuation recommendations for management.
• Forecast key business metrics using analytical techniques and produce reports with meaningful impact.
• Ensure data quality/integrity.
• Advocate and follows best practice process adoption, suggests opportunities to improve operations within scope, leading to business process harmonization.
• Interacts with Business Office Director, HIM Director, Case Management, Physicians and Office Staff, Department Directors, Patients and Patients’ Family, and Administration.

Skills on Resume: 

• Chart Review Management (Hard Skills)  
• Analytics Deployment (Hard Skills)  
• Contract Negotiation (Hard Skills)  
• Budget Oversight (Hard Skills)  
• Audit Support (Hard Skills)  
• Revenue Forecasting (Hard Skills)  
• Data Integrity Assurance (Hard Skills)  
• Stakeholder Communication (Soft Skills)  

Job Summary: 

• Serve as a liaison between the clinical and operational leadership.
• Lead, manage and improve processes, policies and procedures, and technologies.
• Work collaboratively with numerous other system leaders in developing and implementing systems and processes to support quality patient care.
• Assist as a team member in the development, implementation and maintenance of internal controls and policies to maintain sound billing practices.
• Establish best practice protocols and highest quality outcomes.
• Utilize knowledge of federal and state regulations to ensure compliance.
• Provide leadership, feedback, coaching, counseling, guidance and direction 
• Management of Revenue Integrity Operations (account and claim edit management), missing charges, charge trigger methodology, CDM, fee schedules and charge capture.
• Execute payer contracts to include determining payment variances with effective resolutions.
• Prepares annual departmental budget and is accountable for departmental monthly expenses and budget compliance.

Skills on Resume: 

• Liaison Coordination (Soft Skills)  
• Process Improvement (Hard Skills)  
• Collaborative Leadership (Soft Skills)  
• Policy Implementation (Hard Skills)  
• Regulatory Compliance (Hard Skills)  
• Leadership Development (Soft Skills)  
• Revenue Integrity Management (Hard Skills)  
• Budget Management (Hard Skills)  

Job Summary: 

• Investigate and advise on matters relating to technical or professional billing, coding, or regulatory requirements in turn for documentation, charge capture, or coding activities.
• Keep abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices
• Lead and conduct focused charge capture and coding audits on various topics and compliance aspects.
• Develop, assess, and adapt clear and effective revenue cycle and billing policies and procedures, training, communications and awareness material from a compliance perspective
• Assist in identifying and evaluating good practices, both internal and external, utilize existing venues to foster information sharing and transfer.
• Instill accountability, monitor productivity and quality of work, and provide technical training and leadership development courses pertinent to the service line.
• Create work plans around remediation of identified gaps.
• Communicate performance opportunities/issues to inform management and staff at all levels, motivates and incentivizes
• Ensures appropriate management and coordination of government, payer, and internal audits.
• Ensures the planning and completion of complex studies and audits to improve operational and financial effectiveness of the health system.

Skills on Resume: 

• Regulatory Compliance (Hard Skills)  
• Industry Knowledge (Hard Skills)  
• Audit Leadership (Hard Skills)  
• Policy Development (Hard Skills)  
• Best Practices Evaluation (Hard Skills)  
• Accountability Management (Soft Skills)  
• Communication Skills (Soft Skills)  
• Audit Coordination (Hard Skills)