[Hiring] Revenue Integrity Manager @Memorial Healthcare

Role Description

The Revenue Integrity Manager provides operational leadership for Revenue Integrity functions, overseeing staff and workflows to ensure accurate, compliant, and timely charge capture, billing readiness, reimbursement optimization, and revenue protection across the health system.

Responsibilities

• Manages and monitors staffing activities including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
• Periodically tests samples of departmental charges to evaluate whether staff members are performing correctly, and controls are operating as designed.
• Works with RCM and departmental staff to provide as-needed retraining as well as regular periodic updates for all charge capture staff.
• Monitors and provides training, support and troubleshooting to both application teams and end-users to facilitate proper usage and continuous learning.
• Manages applications projects including workflow analysis, end-user validation, acceptance, go-live, and maintenance using standard project management methodology.
• Sets project deadlines and deliverables for specific modules and analysis.
• Manages the debugging and enhancements processes including the design and upgrades to existing systems in order to ensure up-to-date and reliable functionality.
• Utilizes subject matter expert skills to assist MHS leaders with analyses of billing, coding, and documentation requirements for payer coverage and payment of services affecting their service lines and initiatives.
• Designs and evaluates the tools and processes used to capture charges in each MHS department.
• Updates the design of tools to empower departmental staff to accurately post charges efficiently, without rework.
• Designs and implements controls to empower departmental leaders to ensure staff have captured charges accurately and timely.
• Ensures Epic charge-related work queues are timely and correctly cleared.
• Selects opportunities identified by team to implement and improve existing processes using information technology and ensures alignment with strategic initiatives of the organization.
• Manages the planning of application development and deployment; educates and promotes adherence to the organization's software compliance standards within the team.
• Strategic focus: based on regulatory and industry updates, MHS strategic initiatives, end-user feedback, and other information, identifies and achieves opportunities to improve charge capture efficiency and accuracy, eliminate missed charges, eliminate billing rework, and improve MHS net revenue.
• Keeps current, timely reads, and analyzes Medicare, Medicaid, and other technical guidance to determine how they affect Memorial Healthcare System (MHS) capture.
• Develops, recommends, and implements plans to comply with regulatory updates as approved by the Director of Revenue Integrity and in collaboration with responsible MHS leaders.
• Develops annual CDM CPT/HCPCS updates and implements as approved by the Director of Revenue Integrity.
• Oversees the maintenance of CDM-driven CPT/HCPCS coding requirements.
• Develops annual CDM Fee Schedule updates and implements as approved by the Director of Revenue Integrity.
• Updates Price Transparency Standard Charges file in accordance with regulatory requirements.

Qualifications

• Bachelors in Finance or a related field Required.
• 5+ Years of functional/core experience in hospital billing systems/medical billing (specifically EPIC software) Required.
• 5+ Years of experience in a supervisory or leadership capacity Required.
• Epic Charge Router Certification (EPIC CHG ROUTER) - EPIC Certification (EPIC) Preferred.
• Epic Resolute Billing Certification (EPIC BILLING) - EPIC Certification (EPIC) Preferred.
• Certified Professional Coder-Hospital (CPC) - American Academy of Professional Coders (AAPC) Preferred.
• Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) Preferred.
• Registered Health Information Technician (RHIT AHIMA) - American Health Information Management Association (AHIMA) Preferred.
• Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) Preferred.

Requirements

• Expert knowledge of Epic revenue integrity tools, including Charge Records (EAP), Charge Router/Charge Handler, and Revenue Guardian.
• Working knowledge of CPT, HCPCS, and ICD-10 coding systems and their application within healthcare billing, reimbursement, and regulatory compliance processes.
• Demonstrated critical thinking and analytical skills, with the ability to evaluate complex situations, identify solutions, and make sound business decisions.
• Strong verbal and written communication skills, with the ability to effectively convey information and collaborate with diverse stakeholders.
• Ability to exercise independent judgment and discretion in managing priorities and addressing operational challenges.
• Capable of working autonomously with minimal supervision while maintaining a high level of accountability and performance.
• Proven ability to perform effectively in a fast-paced, dynamic environment and respond appropriately to changing priorities and business needs.
• Strong problem-solving skills, with the ability to take timely and appropriate action in high-pressure situations.

Working Conditions and Physical Requirements

• Bending and Stooping = 40%
• Climbing = 20%
• Keyboard Entry = 60%
• Kneeling = 40%
• Lifting/Carrying Patients 35 Pounds or Greater = 20%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 40%
• Lifting or Carrying > 75 lbs Non-Patient = 20%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 40%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 40%
• Pushing or Pulling > 75 lbs Non-Patient = 20%
• Reaching = 40%
• Repetitive Movement Foot/Leg = 0%
• Repetitive Movement Hand/Arm = 60%
• Running = 0%
• Sitting = 60%
• Squatting = 40%
• Standing = 60%
• Walking = 60%
• Audible Speech = 60%
• Hearing Acuity = 60%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 60%
• Distinguish Color = 60%
• Seeing - Far = 60%
• Seeing - Near = 60%
• Bio hazardous Waste = 20%
• Biological Hazards - Respiratory = 20%
• Biological Hazards - Skin or Ingestion = 20%
• Blood and/or Bodily Fluids = 20%
• Communicable Diseases and/or Pathogens = 20%
• Asbestos = 0%
• Cytotoxic Chemicals = 20%
• Dust = 60%
• Gas/Vapors/Fumes = 20%
• Hazardous Chemicals = 20%
• Hazardous Medication = 20%
• Latex = 20%
• Computer Monitor = 60%
• Domestic Animals = 20%
• Extreme Heat/Cold = 0%
• Fire Risk = 0%
• Hazardous Noise = 20%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 20%
• Magnetic Fields = 20%
• Moving Mechanical Parts = 20%
• Needles/Sharp Objects = 0%
• Potential Electric Shock = 20%
• Potential for Physical Assault = 0%
• Radiation = 20%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 20%