MANAGER of REVENUE INTEGRITY
Premier Health Partners - Dayton, OH
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Premier Health System Support110 N. Main St. Dayton, OH 45202Department: FinanceFull Time/ 8am-5pm (Monday through Friday)Under the general direction and guidance of the Director of Reimbursement, the Manager of Revenue Integrity is responsible for the daily operations of the Charge Master staff. The Manager is responsible for developing standards and ensuring the integrity of the Premier Health Hospitals revenue. This includes the following critical components: managing all aspects of the Charge Description Master and fee schedule formulation(s), review and maintenance of charging practices to optimize revenue generation, building and monitoring compliance with third party payer requirements; manage the charge entry and reconciliation process, collaborate with all service lines across the system; policies and procedures development, and modification and maintenance of the hospital CDM. The Manager of Revenue Integrity also is responsible for developing a charge audit/capture/reconciliation process and ensuring charges are maximized for reimbursement. The Manager must have a strong understanding of Medicare & Medicaid regulations as well as understanding implications of CDM changes to Managed Care contracts.The Manager of Revenue Integrity is responsible for the pricing of all charges associated with charge master and charge build. This includes maintain the fee schedules which drive hospital pricing onto claims. The Manager is responsible for the annual rate increase across all Premier Health hospital departments and the annual code changes published by both the American Medical Association (AMA) and Medicare (CMS). The Manager participates in compliance and billing related activities and denials root cause and process improvement, as appropriate.QualificationsEducationMinimum Level of Education Required: Bachelor's degreeType of degree: Finance or Related fieldPreferred educational qualifications: Graduate DegreeLicensure/Certification/RegistrationEpic Hospital Billing or Epic Charge Master is preferred. Coding certification in at least one of the following is also preferred: CPC, CPC-P, RHIA, RHIT, and/or certification in auditing and/or Healthcare compliance. Designation of proficiency in Hospital Billing and Charge Master is required.ExperienceMinimum Level of Experience Required: 5 - 7 years of job related experiencePrior job title or occupational experience: Minimum of five to seven years in hospital finance and or healthcare reimbursement. 3 to 5 years of prior management experience required.Other experience requirements:A strong understanding of healthcare reimbursement requiredKnowledge of CPTs, APCs, DRGs, and HCPCS code is requiredCurrent knowledge hospital billing practices is required.Current knowledge of Medicare and Medicaid regulations is required.Two years of project management experienceExperience in working with upper management, physicians, and information systems is requiredFile maintenance experience requiredReport writing experience requiredUnderstanding of Managed Care contracts and languageKnowledge/Skills/AbilitiesLead projects and work with external consultants when necessaryAdept analytical skills and a proven strong attention to detailsDevelop effective solutions for complex business challengesAbility to research and evaluate informationStrong interpersonal skills necessary to interact with all departmentsStrong written and communication skillsAble to prioritize and coordinate multiple projects simultaneouslyStrong leadership skills
Created: 2024-09-18