Revenue Integrity Manager

Department:
Revenue Integrity

Schedule/Status:
8am-500pm; Full Time

Standard Hours/Week:
40

General Description:
The Revenue Integrity Manager is responsible for promoting and demonstrating Parrish Healthcare's Culture of Choice®; actively and effectively participates in ensuring strategic goals and objectives are met or exceeded; provides the management and oversight necessary to ensure assigned functional area(s) have the proper resources, metrics, and talent in place to effectively fulfill our mission to provide Healing Experiences for Everyone all the Time® and achieve organizational strategic (Game Plan) goals. The Manager assumes 24-hour responsibility and accountability for assigned functional area(s). This position reports to the Executive Director of Revenue Cycle.

Key Responsibilities
HEALING COMMUNITIES | GROWTH

• Manages operational planning within assigned functional area(s) to anticipate current /future service solutions.
• Manages implementation of growth strategies to support achievement of Parrish Healthcare Game Plan goals.
• Assures the achievement of departmental dashboard metrics within each strategic pillar (People, Service, Quality, Growth, Finances); takes immediate and effective steps to assure national benchmarks are achieved or sustained.

HEALING EXPERIENCES| SERVICE

• Manages departmental systems, processes, policies, and procedures that result in assigned area(s) of responsibility and care partners always providing excellent service excellence as measured by national best-practice benchmarks.

SYSTEM RELIABILITY | QUALITY & SAFETY

• Manager optimizes the patient charge structure for revenue capture and billing within the regulatory and payer compliance guidelines. Develop, manage, and reinforce process improvement activities in areas of charge capture integration and reconciliation, CDM compliance, Managed-Care Contracting, Payer Medical and Billing Policies to include:
  • Research, audit, and analyze data, creating solutions and/or alternatives; presenting data to stakeholders.
  • Manage CDM activity and accuracy of 98%+
  • Vendor liaison for all associated engagements. Maintain direct contact with internal and external vendors associated with revenue integrity initiatives.
  • Monitor and report monthly denials and late charges.
  • Works closely with the Billing Manager to ensure claims data represents what was performed and billed appropriately per payer-directed requirements, thus maximizing reimbursement.
  • Ensures revenue cycle strategic goals and objectives are met or exceeded by providing the management and oversight necessary to ensure areas of responsibility have the proper resources, metrics, and talent in place to effectively achieve Game Plan Goals.
• Manages systems, processes, policies, and procedures that result in a continuous improvement environment within which assigned area(s) and care partners always achieve national best/leading-practice standards for quality and safety as measured by CMS, Joint Commission, and other regulatory agencies pertinent to areas of responsibility, holding self and others accountable for actions and outcomes.
• Responsible for the adherence to all Parrish Healthcare policies and procedures as well as regulations and codes established by federal, state, and local governments affecting professional practice and industry regulations. Leads necessary certification, accreditation, and audit procedures; and ensures that reports required by regulatory agencies are prepared and submitted within established timeframes.

CARE PARTNER ENGAGEMENT | PEOPLE

• Manages systems, processes, policies, and procedures that result in an inclusive, collaborative, healing work environment within which national best/leading-practice standards for employee engagement are achieved as measured by effective performance management, problem-solving and conflict resolution, mentoring aspiring care partners, and inspiring care partner commitment to our mission, vision, values, and safe care pledge.
• Maintains skills and knowledge within professional practice for self and for assigned care partners; able to step in and serve as back up to assigned care partners to cover staffing needs as necessary.

COMMUNITY INVESTMENT | FINANCE

• Manages systems, processes, policies, and procedures that result in effective planning and administration of annual budget(s); productive, cost efficient and effective operations within assigned functional area(s); and effective corrective actions for any operating expenses that deviate from budget.
• Performs other duties as assigned. Knows fire, disaster and safety procedures and regulations as pertains to the work area.

Requirements:

Formal Education:

• Bachelor's degree required within related field. Associate's Degree (AA or AS) in related field with two years supervisory or management experience may be substituted for Bachelor's Degree.

Work experience:

• 3 years to < 5 years of experience in related area with two of those years being supervisory or management experience. Hospital Facility and Provider Group Coding and/or billing experience preferred.

Required Licenses, Certifications, Registrations:

• Current Sigma Six Green Belt certification or required within one (1) year of employment.
• AHIMA or AAPC Certified Coder, preferred.

Full Time Benefits:
Eligible to participate in a number of PMC-sponsored benefits, including:

• Benefits Start on Day 1
• Health, Dental and Vision Insurance
• 403(b) Retirement Program
• Tuition Reimbursement/Educational Assistance
• EAP, Flex Spending, Accident, Critical and Other Applicable Benefits
• Annual Accrual of 152 Personal Leave Bank (PLB) Hours

Parrish Healthcare is a caring community of healthcare professionals passionate about excellence and fulfilling our mission of providing Healing Experiences For Everyone All The Time®.

Parrish Healthcare has a Culture of Choice®. This means a we have a healing work environment that empowers people to aspire to be their very best. We partner passionate, talented and skilled people in the right role with the right resources. We provide a clear and strategic direction to achieve superior results on behalf of the communities we serve.