Revenue Integrity Manager
Classification: Exempt
Reports to: General Counsel
Date: July 2024
Summary
The Revenue Integrity Manager oversees the billing compliance for the Company and its employed healthcare providers. Coordinates the implementation, monitoring, and enforcement of coding and billing compliance initiatives for the Company, to comply with applicable laws and regulations as they relate to medical documentation, billing procedures, and associated requirements. The individual will work with senior management to effect change within the Company’s billing and coding practices and will supervise medical & coding auditors to perform regularly scheduled audits.
Revenue Integrity Manager Job
Responsibilities
- Creates and implements internal audit schedule to review billing, documentation, and coding practices of all healthcare providers.
- Recommends changes to ensure the bills are compliant and to minimize the exposure to monetary penalties.
- Responds to applicable questions, issues, and reports of potential issues in coordination with Compliance Officer.
- Independently assesses critiques and makes authoritative recommendations for revisions to coding and documentation techniques and policies. Monitors such on an ongoing basis and ensures that approved recommendations are implemented.
- Assists with training and education for providers and staff to improve the quality of coding and documentation.
- Stays abreast of all new and revised codes, requirements, and regulations and compliance matters.
- As requested, participates with any third party (Medicare, Medicaid, etc.) audit for the Company or its employed healthcare providers.
Revenue Integrity Manager
Education & Experience
- Bachelor’s Degree or four years’ experience in related field preferred
- Certified coder (CPC) and/or Certified Professional Medical Auditor (CPMA) with a minimum of 5 years coding and auditing experience.
- Two or more years’ experience with CPT/ICD coding, and E&M experience
Knowledge, Skills and Abilities
- Strong analytical skills required to monitor and direct regulatory monitoring
- Must have proven organizational and planning skills as well as the ability to handle multiple tasks simultaneously.
- Effective interpersonal skills required to interface between clinical and non-clinical staff, and department leaders.
- Excellent time management skills with a proven ability to meet deadlines.
- Familiarity with laws, regulations, and best practices.
Physical Requirements
While performing the essential functions of this job, the following are required:
- Talk, hear, and communicate with people over the telephone;
- Use hands and fingers to operate a computer and telephone;
- View computer screens for extended periods of time;
- Sit at a desk for extended periods of time; and
- Regular, predictable attendance.
Job Type: Full-time
Schedule: Monday to Friday
Work Location: Sparks, MD
Healing Partners is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, sexual orientation, gender identity, marital status, civil union status, national origin, ancestry, age, parental status, disabled status, veteran status, or any other legally protected classification, in accordance with applicable law.
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