Must be fully vaccinated for COVID-19 including 2 doses of a 2-dose series or 1 dose of a 1-dose series plus 14 days beyond the final dose prior to start date.
PeaceHealth is seeking a Manager Revenue Integrity for a Full Time, Day position.
Responsible for managing the routine review of the PeaceHealth Charge Master for accuracy of CPT/HCPCS coding, including annual pricing and code set updates. Focuses on improving revenue and ensuring compliance with federal, local and third-party payer requirements.
- Manages the routine review of the charge master for accuracy of CPT/HCPCS coding, including annual pricing and code set updates. Works to improve revenue and ensures compliance with federal, local and third-party payer requirements, ensures required billing elements are in the system, encounter forms are kept up-do-date and used appropriately, and new charge code requests are handled timely and efficiently.
- Educates department leadership relative to charge master issues and takes ownership of issues and facilitating effective outcomes.
- Oversees the daily operation of the Revenue Integrity team. Manages, coaches, mentors and trains caregivers. Conducts performance monitoring and evaluations. Manages work flow and allocation of staff resources to meet the needs of PeaceHealth entities, providers and other customers.
- Conducts annual review of the charge master in conjunction with yearly updates of the CPT and HCPCS Level II codes to ensure accurate claims submission to third party payers.
- Ensures charges from various clinical departments are reviewed, tested, and reconciled according to the professional charge master set up. Coordinates all departments’ charge entry forms to ensure they are updated to reflect the annual price changes and ensure each clinical department has a solid business process procedure for how charges are entered into the system.
- Participates in system implementations to ensure the charge entry is designed to meet regulatory billing requirements from various third-party payers and to achieve maximum revenue collection for the hospital.
- Researches regulatory and billing requirements as related to clinical coding and communicates relevant changes to respective departments.
- Performs statistical analysis and comparisons of charge capture and charge rates to assist management to identify areas of opportunity for enhanced compliance with appropriate laws, regulations, or contractual terms or to enhance reimbursement for services and items billed.
- Determines and reports charge master metrics and performs associated analyses.
- Synthesize high-level business and statistical data into actionable information.
- Reviews results of periodic audits and takes appropriate action as indicated. Facilitates the regulatory submission of the charge master to governmental entities.
- Performs other duties as assigned.
- Bachelor’s degree in Business Administration, Finance or Health Care Administration required. or a combination of education and professional experience that provides the incumbent with the requisite knowledge, skills and ability to successfully perform the job.
- Master’s degree preferred.
- Minimum five years’ experience in revenue cycle, including revenue integrity, charge capture, compliance, pricing and reimbursement required.
- Minimum two years supervisory experience required.
- Ability to deliver financial results for areas of accountability.
- Extensive knowledge of accreditation standards, legal and regulatory requirements related to credentialing, including NCQA and CMS.
- Extensive knowledge of delegated credentialing programs and managed care credentialing, including knowledge of contracts, processes and requirements.
- Strong leadership skills, including ability to manage and work collaboratively as a team.
- Strong critical thinking, analytical and problem-solving skills.
- Strong interpersonal communication and relationship skills.
- Excellent organizational and project management skills.
- Sound judgment; initiative; flexibility; and detail-oriented.
- Understanding of computer technologies related to credentialing.
- Understanding of performance improvement methodologies and processes.
- Ability to create reports with Cactus credentialing database and Access; analyze, interpret and effectively display data into meaningful reports.
- Excellent customer service skills.
- Ability to effectively prioritize and coordinate multiple projects; use independent judgment and decision-making.
- Proficient with MS Office applications.
SHARED SERVICES PHYSICAL / COGNITIVE REQUIREMENTS
- Work requires fairly light physical exertion from up to 65% of the time.
- Ability to lift objects weighing 30 lbs. or less.
- Work is performed under normal working conditions with adequate lighting and ventilation.
- Job duties frequently require intense concentration and attention to detail (up to 65% of work time).
See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.
For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state, or federal laws.