The Manager Revenue Integrity is responsible for planning and directing all charge master, charge capture, and payer contract modeling activities for Benefis Health System. The incumbent is responsible for the development and maintenance of productive relationships with Benefis' contracted payers. The incumbent provides leadership in developing and implementing best practices within areas of responsibility in support of organizational strategic direction and objectives.

EXEMPT

This position is critical to the success of the overall Revenue Cycle function and is the recognized delegate for the Controller and CFO for all issues relating to the charge master, charge capture, and payer contract modeling.

Work situations are varied and this position operates independently requiring strategic thinking and focus, analytical expertise, leadership, independent judgment, discretion, problem-solving, organization, and prioritization. Major decisions are subject to the review and approval of the Controller or CFO.

Ensure the accuracy, integrity, and timeliness of gross revenue related financial information produced for internal, external reporting, and for analytical purposes.

Maintain and enhance chargemasters; reviews organizational charge structures to ensure charges accurately reflect services and supplies provided and are consistent with current industry best practices.

Ensure compliance of chargemasters while providing tools and education to the clinical operations management on their charge entry processes.

Coordinate pricing strategies and pricing optimization projects.

Oversee the revenue charge capture system to promote accuracy and integrity across revenue generating departments of the organization.

Coordinate and oversee regular and systematic reviews of all clinical area to ensure accurate charge entry for all services provided. Identify opportunities for charge capture improvement by implementing and analyzing the results of routine and/or random audits.

Consult with department managers to help develop and implement policies and procedures for the purposes of reconciling charges posted in the billing system with other source information.

Develop tools for the purposes of tracking and identifying potential areas of lost revenue.

Stay apprised of ICD-10 coding standards/updates and assists in the delivery of ICD-10 education and training to coding staff as needed.

Review changes in pricing, CPT codes, HCPCS codes, modifiers, and revenue codes for accuracy and compliance with all applicable billing guidelines

Ensure accuracy of chargemaster tables which enables appropriate billing and financial data.

Provide analytical and advisory support to Revenue Cycle and operational management relative to revenue related financial results.

Facilitate compliance with Price Transparency regulations.

Oversee the maintenance, integrity, and synchronization of charge master tables in multiple billing applications.

Understand coding classification systems, such as ICD-10-CM, MS-DRG, and APR-DRG.

Uses knowledge of current reimbursement methods, contract terms, and modeling principles to effectively oversee the operation and maintenance of the expected reimbursement system to ensure reimbursements are properly captured and optimized.

Primary responsibility for Axiom Contract Management, and pricing & contract modeling within Change Healthcare Estimator. This work will be performed in coordination with the Decision Support and Revenue Cycle areas.

Maintain in-depth understanding of payer reimbursement methods

Serves as internal consultant for Patient Billing Services with respect to payer billing issues and reimbursement.

Monitors payer compliance with contract reimbursement terms.

Identifies and recoups underpayments from all payer sources as applicable.

Responsible for the timely load of the COMPdata system, correction of errors, and coordination with the Decision Support department for reconciliation and reporting

Administrate and maintain the MediTract Contract Management system. Educate management in the use of the system, loading of contracts, and problem troubleshooting.

Generate payer scorecards with key performance indicators to monitor payer performance and assist in payer discussions and negotiations.

Creation, oversight, and maintenance of systems and processes that are efficient, effective, and incorporate appropriate internal controls and best practices.

Internal contacts include all levels of management and staff throughout the organization at times requiring in-depth interactions. External contacts may include regulatory agencies, professional service providers, information technology providers, and suppliers.

The incumbent is expected to participate on cross-functional teams and serve as project leader on assigned projects.

Stay apprised of current regulatory and economic trends that may impact the financial results of the organization. Advises management relative to high impact risks and opportunities that may occur.

Oversee and direct the timely preparation of all applicable Revenue Integrity reports, assigns projects, maintains completion schedules, and follows up as appropriate and directed.

Manage business relationships.

Provide leadership and managerial guidance.

Establish performance expectations and provide coaching to achieve positive results.

Recognize effective performance, and address performance needing improvement in an honest and timely manner. Empower staff to make decisions by providing information and tools.

Select, manage, and evaluate the performance of employees and initiates disciplinary action as necessary.

Maintain positive communication and coordinates work efforts as applicable and directed within Finance, Revenue Cycle, HIM, Case Management, and other areas as applicable.

Contribute to the success of the organization by meeting organizational competency expectations, continuously learning, and by performing other duties as needed or assigned.

Prepare information and creates presentations for senior leadership, the board and various organizational committees.

Effectively prioritize and balance multiple tasks and activities, thus ensuring that assignments are completed on time.

Is flexible, organized and functions well under stressful situations. Maintains a good working relationship with the Decision Support department as well as with all other Benefis Health System departments.

Consistently demonstrates initiative and a professional, self-directed approach to department responsibilities and an ability to meet deadlines.

Stay current on developments in healthcare and healthcare regulations through professional development, involvement in professional organizations, and attendance at professional meetings, conferences, or workshops.

Accept additional projects and responsibilities as assigned.

Demonstrate the ability to deal with pressure to meet deadlines, to be accurate, and to handle constantly changing situations.

Demonstrate the ability to deal with a variety of people, deal with stressful situations, and handle conflict.

Professional Requirements:

Represent the organization in a positive and professional manner.

Actively participate in performance improvement and continuous quality improvement (CQI) activities.

Coordinate efforts in meeting regulatory compliance, federal, state and local regulations and standards.

Communicate and complies with the Benefis Health System Mission, Vision and Values as well as the focus statement of the department.

Comply with Benefis Health System Organization Policies and Procedures.

Comply with Health and Safety Standards and Guidelines.