REMOTE Revenue Integrity Process Manager - Revenue Integrity Process

(REMOTE) Revenue Integrity Process Manager - Revenue Integrity Process

SUMMARY OF POSITION:

100% Remote Position

This position serves as the principal revenue cycle person of assigned service line. He/she supports the revenue cycle functions from start to finish by collaboration, analysis, process mapping and education with support area providers, clinical and operations leadership, and revenue cycle subgroups. This position influences all charges through charge capture process mapping, risk mitigation through education and problem solving through analytics.

Collaboration occurs between RIPM and operations, clinicians, IS, compliance, finance, revenue cycle subgroups, their leadership and team members. The RIPM is viewed by the service lines/departments as the leader of the departmental revenue cycle in general and directed our focus to where it was needed to optimize charge/cash capture. This position reports to Team Manager Revenue Integrity and the Revenue Integrity Support Services Leadership.

The percentage of time spent performing essential functions is 95%. Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

• Serve as expert for Special Projects (end of PHE, yearly updates, cross-entity management) with regard to regulatory changes, internal changes and unexpected coordinated projects.
• Serve as subject matter expert on developing, documenting, and validating charge capture process workflows for assigned department(s), and understand/coordinate/develop associated charge reconciliation processes for each process flow and monitor regularly.
• Request and provide post-implementation validation of billing system edits to ensure claims contain appropriate codes, activity-type, revenue codes and functionality.
• Manage requests for new charges, providers, services, and prices through point-of request through charge validation when build/addition is complete. Report on additions routinely while working with Finance (pricing) and CDM (Chargemaster team) internal workflows.
• Serve as expert on CMS regulations, OIG hot topics, final rule updates, and payer policies on new and existing services, including who can perform, locations, how to bill, codes to use, documentation required to support, supervision guidelines, etc. and make recommendations to the clinicians and department.
• Coordinate information on charges, regulations, system set-up, charge capture for technical charge setup, validation and compliance for all Penn State Health hospital and clinic locations by gathering information from government and payer websites, practitioner clinical workflow, billing system needs, and practitioner charge capture methods.
• Serve as liaison between IT and practitioners by coordinating clinical EMR needs with informaticists with goal to improve the provider’s experience with the EMR; reporting leadership routinely on the outcome of improvement projects.
• Serve as the revenue cycle expert and compliance liaison with every new provider to educate on documentation and coding. Audit every new provider using a sample of 10 random encounters. Provide findings and education. Track results for continued improvement. Deliver results of any provider-specific audits and work with the provider to develop a corrective action plan if required.
• Analyze and access benchmarking analytics (Vizient) to identify outliers (risk/revenue opportunity) and share data with the department. Provide analysis and feedback for necessary documentation changes to mitigate risk or optimize opportunity.
• Coordinate multiple units (operations, clinical, billing, coding, scheduling) to mitigate revenue loss through monthly adjustment and denials analysis; providing educational feedback on charge capture, documentation, and diagnosis selection to both coding and clinical areas affected.
• Manage relationship between Finance, Revenue Cycle and Operations regarding compensation through tasks such as investigating and responding to RVU questions related to charge capture/reconciliation through data analysis and sample audit.

• Bachelors, or equivalent work…