Revenue Integrity Manager

Hennepin Healthcare • Minneapolis, MN, United States • $200k - $250k / year • 4m ago

Hennepin Healthcare is an integrated system of care that includes HCMC, a nationally recognized Level I Adult Trauma Center and Level I Pediatric Trauma Center and acute care hospital, as well as a clinic system with primary care clinics located in Minneapolis and across Hennepin County. The comprehensive healthcare system includes a 473-bed academic medical center, a large outpatient Clinic & Specialty Center, and a network of clinics in the North Loop, Whittier, and East Lake Street neighborhoods of Minneapolis, and in the suburban communities of Brooklyn Park, Golden Valley, Richfield, and St. Anthony Village. Hennepin Healthcare has a large psychiatric program, home care, and operates a research institute, philanthropic foundation, and Hennepin EMS. The system is operated by Hennepin Healthcare System, Inc., a subsidiary corporation of Hennepin County.

Equal Employment Opportunities: We believe equity is essential for optimal health outcomes and are committed to achieve optimal health for all by actively eliminating barriers due to racism, poverty, gender identity, and other determinants of health. We are committed to equitable care and working in an environment that celebrates, promotes, and protects diversity, equity, inclusion, and belonging.

SUMMARY:
We are currently seeking a Revenue Integrity Manager to join our team. This full-time role will primarily work remote (SHIFT).

Purpose of this position: Responsible for the management and strategic direction of the Revenue Integrity department. Manages the organization’s revenue integrity and charge capture processes by working with all revenue producing departments to ensure the organization is charging appropriately and accurately for the services provided in accordance with Medicare, Medicaid, and other third-party payor rules. Assists in pricing studies and the management of the organization’s pricing policy.

RESPONSIBILITIES:

Manages the Revenue Integrity team and develops long range plans for department activities, monitoring results to ensure compliance with expectations.
Manages, coordinates, monitors, maintains, and analyzes compliance of the hospital’s chargemaster, ensuring all requested updates are completed appropriately in the electronic health record system.
Oversees the overall maintenance and use of the chargemaster tool/software utilized.
Communicates expectations and oversees the activities of supervisor in areas that include staffing, employee discipline, training, evaluation, feedback, and recognition.
Develops tools and processes to record and monitor progress of issues worked by analysts.
Works collaboratively with all Revenue Cycle Management (Coding, Billing/Claims, etc.), Finance, Compliance, Information Services & Technology, Utilization Management, Office of Medical Staff, as well as hospital and clinic operating departments to address issues and arrive at solutions.
Researches and responds to questions from all departments on charging, pricing, billing and documentation requirements.
Manages quarterly and annual CPT/HCPCS code updates processes, including review, analysis, and implementation according to established policies and procedures.
Represents Revenue Integrity on organizational teams, committees, and task forces, planning and delivering presentations as needed to provide overall education on appropriate charge capture practices.
Advises and collaborates with the Compliance department, legal counsel and outside consultants to analyze, review and assess identified billing, coding, charging and compliance issues.
Recommends policies and procedures for administrative approval which impact charge capture, charge reconciliation, and pricing practices.
Works collaboratively with Payor Contracting team to price all new items and services in accordance with the HHS Pricing Policy.
Responsible for understanding impacts of Federal and State proposed and final regulations, coding changes, national and local coding determinations, etc. as they change and impact the chargemaster and revenue integrity at HHS.
Performs other duties as assigned, but only after appropriate training.

QUALIFICATIONS:

Minimum Qualifications:

Bachelors degree in Health Information Management, Health Care Administration, Nursing, Business Administration, or related healthcare concentration area.
Minimum 7-10 years of experience in Revenue Integrity and chargemaster management in a hospital setting.
Experience reviewing medical record documentation to support services billed.
Experience reviewing hospital UB and 1500 claims for accuracy and compliance.
Experience with chargemaster review/audit/workflow tools.

-OR-

An approved combination of education and experience.

Preferred Qualifications:

Minimum of 10 years’ experience in a directly related field (chargemaster/Revenue Integrity).
Epic Certification in Resolute HB and/or Resolute PB.
CHRI, RHIA, RHIT, CCS, CPC, or CRIP.

Knowledge/ Skills/ Abilities:

Extensive knowledge and understanding of hospital revenue cycle operations (registration, charge capture, coding, claims, payment posting).
Extensive knowledge of CPT, HCPCS, and revenue codes.
Extensive knowledge of and the capacity to review and interpret third-party payor requirements/contracts, billing guidelines, and state and federal regulations for accurate and compliant healthcare charging and billing.
Extensive knowledge of NCCI edits and Medicare LCDs/NCDs.
Extensive understanding of reimbursement theories to include DRG, OPPS, HCC, and managed care.
Ability to manage large complex projects assignments, investigate, analyze, and resolve issues at a high level.
Strong attention to detail.
Excellent communication, presentation, organizational, analytical and problem-solving skills. Able to present to both small and large (up to 100) groups.
Strong MS Office Suite skills with intermediate to advanced Excel skills.

Please Note: Offers of employment from Hennepin Healthcare are conditional and contingent upon successful clearance of all background checks and pre-employment requirements.

Department: Revenue Integrity
Primary Location: MN-Minneapolis-Downtown Campus
Standard Hours/FTE Status: FTE = 1.00 (80 hours per pay period)
Shift Detail: Day
Job Level: Manager
Employee Status: Regular
Eligible for Benefits: Yes
Union/Non Union: Non-Union
Job Posting: Oct-29-2024

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