Manager, Revenue Integrity

Your job is more than a jobReporting to the Revenue Integrity Director, the Manager of Revenue Integrity plays a leadership role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation. The Manager of Revenue Integrity must maintain advanced knowledge revenue cycle processes to aid in the implementation of regulatory standards that assist LCMC in cash collection while accurately complying with billing guidelines. This includes extensive knowledge of all aspects of the revenue cycle including the registration, coding, billing and collection processes as well as government and payer regulations for both professional and facility billing. This position is responsible for the analysis and assessment of diverse data relating to the revenue cycle. Acting as an internal consultant, this Manager provides essential quality reports, and advice and improvement recommendations to management along all service lines. The Manager of Revenue Integrity is required to understand and communicate complex issues and changes relating to regulatory compliance and third-party reimbursement to the department(s) involved, maintaining records of their notification, accountability and compliance. This position works closely with LCMC Hospitals and service line departments to provide accurate, critical information for identification of areas needing immediate attention to improve revenue results.Your EverydayGENERAL DUTIESDirects, sets vision, and defines roles and responsibilities for accountable departments, including training, delegating tasks, overseeing daily activities, mentoring, guiding through demonstration of best practices and offering opportunities for professional development. Ensures the highest standards for the hiring selection, training, orientation and assignments of department staff. Provides leadership to direct reporting management staff with regards to the evaluation, promotion, resolution of employee relations/disciplinary concerns and the termination of employees.Facilitates the dissemination of information regarding government and third-party payor regulations and requirements to clinical departments, providers, management and staff, as applicable. Oversees communication of coding and billing updates published in third-party payer newsletters / bulletins and provider manuals to all stakeholders as appropriate.Ensures adequate training and education occurs to both providers and hospital departmental staff regarding accurate charge selection / entry and documentation requirements.Develops, implements and maintains Charge Reconciliation, CDM Management and Charge Capture policies, procedures and training materials.Oversees CDM maintenance and development, including correct coding and charging, updating of pricing, adding new service lines, inactivating unused CDM service lines within established LCMC Policies and Procedures. Oversees research of billing and coding requirements when new procedures and / or supplies are introduced. If appropriate to bill for new services, ensures all billing systems are set up correctly, tested, and monitors initial charging of services for proper billing as well as following claims for initial reimbursement. Collaborates with clinical leaders and hospital committees to review and evaluate new technologies and formulary items and to establish related charge capture and coding protocols.Liaises (verbal and written) with LCMC key partners such as Finance, Central Business Office, Compliance, HIM, Coding and CDI, Clinical Departments, Information Technology, as well as others.Analyze and influence appropriate action to support accurate reimbursement, by performing appropriate reviews, investigating trends and patterns, and providing education regarding charge capture, charge reconciliation, billing/coding guidelines and denials. Ensures reviews are conducted on an annual basis and / or as otherwise identified, in all areas treating patients to ensure all professional and facility billable charges are captured and coded completely and accurately. Reviews are inclusive of, but not limited to, the departmental CDM and / or fee schedule, encounter forms or charge tickets, subsystems generating charges (especially any mappings in an ancillary charge systems), reconciliation processes, revenue and usage reports, CPT / HCPCS codes, ICD-9 (ICD-10) codes and revenue codes, and government and third-party payor regulations and requirements.Manages team responsible for managing government and third-party payor audits, including RAC, MAC, MIC and charge audits.Develops and maintains a revenue issues database and reporting package. Communicates and coordinates resolution of identified issues with denial, billing error, payment variance, and Managed Care Contracting stakeholders. Presents regular updates on issues and efforts to Revenue Cycle leadership. Reviews, develops, and updates third-party payor contract language related to clinical coding standards and requirements. Participates in internal and external contracted payor discussions and negotiations regarding clinical coding and charging standards.In partnership with the Central Business Office, evaluates, resolves, and remediates billing edits, exceptions, and denials, resulting from charge issues, NCCI or OCE edits and medical necessity.Develops and monitors metrics to ensure functions of the revenue integrity team are performed efficiently as well as with a high degree of accuracy and customer service.The Must-HavesEXPERIENCE QUALIFICATIONSRequired: Five years minimum recent experience in healthcare finance, revenue cycle management, patient accounting and physician billing, coding and documentation preferably in an Academic setting.Strongly Preferred: Previous clinical experience.EDUCATION QUALIFICATIONSBachelor’s Degree In Business / Healthcare related field or work experience equivalent.KNOWLEDGE, SKILLS, AND ABILITIES• Extensive clinical and/or clinical coding knowledge; nursing experience preferred.• Ability to effectively collaborate with physicians and managerial staff at all levels. Must have advanced clinical and coding knowledge.• Ability to manage day to day operations with management of staff and efficient workflow within the Revenue Department• Ability to review, analyze, and interpret managed care contracts, billing guidelines, and state and federal regulations. Background in managed care contract operations and/or billing compliance highly desired.• Strong quantitative, analytic, and problem-solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions. Strong organizational skills to keep track of multiple priorities of highly detailed information.• Solid understanding of multiple reimbursement systems including IPPS, OPPS, MPFS, DRG, risk, etc.• Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including clinical, administrative, and management staff.• Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook, Excel and Access; Epic experience highly desirable.• Extensive knowledge of charge creation, processing and reconciliation in a health care environment.• Well developed, formal presentation skills• Strong time management, attention to detail, and follow through.WORK SHIFT:Days (United States of America)LCMC Health is a community.Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinaryYour extras• Deliver healthcare with heart.• Give people a reason to smile.• Put a little love in your work.• Be honest and real, but with compassion.• Bring some lagniappe into everything you do.• Forget one-size-fits-all, think one-of-a-kind care.• See opportunities, not problems – it’s all about perspective.• Cheerlead ideas, differences, and each other.• Love what makes you, you - because we doYou are welcome here.LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.Simple things make the difference.1. To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information.2. To ensure quality care and service, we may use information on your application to verify your previous employment and background.3. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed.4. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.