Director of Revenue Integrity CPC

Allied Digestive Health is one of the largest integrated networks of gastroenterology care centers in the nation with over 200 providers and 60 locations throughout New Jersey and New York. As a fast-growing physician-led organization, our dynamic structure encourages physician input and decision-making, while simultaneously offering operational support. Our dedicated, compassionate team of providers prioritize personalized treatment plans for patients that deliver the highest quality of care. All of our doctors are board-certified in gastroenterology and hepatology. Several of them serve as chief of gastroenterology at nearby hospitals, and a number of them have been recognized as top-quality physicians in publications, including but not limited to: Best Doctors in America and Top Doctors New Jersey, and US News Health - US News & World Report. We are excited to announce that we are looking for a Full-Time Revenue Integrity Manager CPC at our Corporate office in West long Branch. The Revenue Integrity Manager CPC responsibilities are: Works with appropriate departments to correct issues related to billing-reimbursement-related questions.Work collaboratively with leadership to assist in developing, project management, and implementing process enhancements to enhance revenue cycle billing and coding compliance with applicable state and federal regulations. Work with health information, external vendors, patient registration, compliance officer, chief medical officer, Business Offices, and Administration on documentation, education coding, and auditing guidelines. Responsible for meeting or exceeding the department's revenue, metrics, and objective coding goals.Assists with compliance audits and investigations with a primary focus on the revenue cycle by reviewing medical records for documentation compliance for CPT, HCPCS, and diagnosis codes determining that regulations are being complied with as evidenced in medical record documentation; and evaluating the appropriateness of billing and coding procedures.Oversee CPT, level II HCPCS, diagnosis coding, and government payer regulations. Actively direct and conduct internal coding/billing audits, investigations, corrective action plans, regulation research, staff, and provider education.Develops, implements, and maintains the Charge Reconciliation, CDM Management, and Charge Capture policies, procedures, and training materials.Providing consultative services to the organization's senior leadership, providers, and staff; providing key contributions to the development of the Compliance audit work plans, awareness, and mitigation of revenue cycle risks; and providing training and coaching to staff. Works autonomously under general supervision with considerable latitude for initiative and independent judgment.Follow changes and policies within the industry, preparing plans and goals to grow with the changes; follow company policy changes and projections that may impact. Oversee Denial and accounts receivable management related to coding, billing, and payer medical policy changes. Performs other related or unrelated duties as assigned to achieve the goals and objectives of the department and the organization.Essential Skills: Intermediate experience with A/R management denial managementIntermediate rudimentary understanding of medical terminology.Excellent problem-solving and organizational skills.Extreme Reliability, Accuracy, and Efficiency when dealing with patients, providers, or third-party payors.Excellent verbal and written communication skills.Ability to use good judgment in highly emotional and demanding situations.Excellent ability to react to frequent changes in duties and volume of work. Maintains confidentiality of sensitive informationAbility to provide leadership and influence others i.e. providers, Ability to foster effective working relationships and build consensus.Ability to mediate and resolve complex problems and issues.Ability to develop long-range coding business plans and strategy.The Revenue Integrity Manager CPC must have the following qualifications and/or experience:Certified CPC, CPB, CRC of CPT, and ICD coding.Bachelor's degree5+ years' experience in Revenue Cycle and coding or auditing physician education experienceProficiency with Microsoft Office products including Word and Excel.Proficiency in PowerPoint presentations Proficiency in AnalyticsSupervisory Responsibility: Staff and Vendor ManagementWe offer a competitive base salary, generous benefits, including: Medical, Dental, Vision, Life Insurance, Voluntary, Time-Off Benefits, EAP, 401K and Commuter Benefits. Job Type: Full-time

Created: 2024-11-27