Manager of Revenue and Expense Integrity

Since 1852, Elwyn has helped people with autism, intellectual, developmental, and behavioral challenges lead meaningful lives. As an internationally recognized nonprofit human services organization, we have always been on the forefront of innovation. Please join us to make a difference in the life quality of children, teens and adults with autism, intellectual and developmental disabilities, and related behavioral health challenges - and feel the resulting pride that will enrich your own life. Providing an excellent benefits package is another way we know that Elwyn is truly a special place to work. We invest in your future while you help care for ours: Generous Paid Time Off Comprehensive Medical/Dental/Vision Benefit Packages Earned Wage Access/On-Demand Pay Paid On-the-Job Training Tuition Reimbursement Career Advancement Opportunities and Growth Flexible Schedules Retirement Savings Plan Elwyn is seeking a Manager of Revenue and Expense Integrity to be responsible for overseeing and managing the financial health of the organization by ensuring accurate revenue recognition and expense management. This role involves the development and implementation of strategies to optimize revenue cycle processes, reduce financial risk, and ensure compliance with regulatory and internal standards. The Manager of Revenue and Expense Integrity will analyze financial data, identify areas for improvement, and work with various departments to identify and implement cost-saving measures and enhance revenue streams. This role is responsible for monitoring and auditing financial transactions, providing detailed financial reports, and ensuring that billing and reimbursement practices are accurate and efficient. The Manager of Revenue and Expense Integrity will work with all levels of employees and management on internal analyses and will support external audits / auditors as needed. This position requires a strategic thinker with a deep understanding of financial processes and the ability to drive organizational financial performance. ESSENTIAL FUNCTIONS: Revenue Cycle Management Ensure that the organization complies with federal and state billing regulations through ongoing auditing and monitoring of clinical documentation, claims and revenue receipts Perform risk-based claims sampling by downloading client accounts receivable data and randomly selecting claims to confirm that services are documented in a way that is consistent with how the services are billed and reimbursed Audit and monitor the management of client funds to ensure compliance with relevant regulations, contractual agreements, and internal policies Coordinate with Revenue Cycle Management, Payor Contracting, Finance, and program/clinical managers to evaluate charging, authorization, and coding structures through retrospective analysis of claims and services data to ensure compliance with applicable healthcare payment integrity regulations Maintain awareness about relevant industry developments pertaining to reimbursement and legal compliance through actively seeking out and reading relevant bulletins, alerts and notices and informing program/clinical managers, leadership, Revenue Cycle Management, Payor Contracting, and Finance to ensure that practices are consistent with payment integrity regulations and with industry best practices Coordinate with Revenue Cycle Management, Program/Clinical Managers, Legal and Compliance to respond to requests and findings from governmental and third-party payors' audits and investigations through tasks including but not limited to presentation and participation during meetings Utilize the electronic health record and billing applications to identify and analyze trends for improvement around documentation, authorizations, coding, and billing Expense Management Develop strategies to manage and reduce organizational expenses while maintaining quality standards Conduct financial analyses to identify trends, variances, and opportunities for cost optimization Review and audit employee expense reports and use of company credit cards to ensure compliance with company policies and procedures, including verifying the legitimacy of expenses claimed by identifying and investigating discrepancies or errors in submitted expense reports Communicate with employees to resolve issues or questions related to their expense reports or use of the company credit card, providing clear guidance on acceptable expenses and documentation requirements Other Provide quarterly reports summarizing the results of auditing and monitoring to Finance leadership, the Compliance Officer, and program/clinical managers, providing insights and recommendations for improvement. Ensure appropriate action plans are developed for any findings Ensure adherence to regulatory requirements and internal policies regarding financial practices Identify inefficiencies in current financial processes and implement solutions to enhance performance Participate in various committees or task forces geared to policy/procedure development and operational improvements Perform other duties as assigned QUALIFICATIONS, EDUCATION AND EXPERIENCE: Bachelor's degree in Finance, Accounting, Business Administration, or a related field (Master's and CPA license preferred) Minimum five years experience in financial management and/or auditing in healthcare or health services environment Demonstrated working knowledge of Medicare/Medicaid regulations, including billing, authorizations, and coding requirements Demonstrated working knowledge and experience of behavioral health and development disabilities services preferred Demonstrated working knowledge of relevant tax laws and regulations related to employee reimbursements Non-profit human service experience preferred Demonstrated ability to work effectively as part of a team Demonstrated solid judgment with the ability to solve problems and make decisions Demonstrated ability to anticipate future needed process changes, identify problem areas, and make recommendations for change Must possess excellent customer interaction, collaboration, presentation, and written and verbal communication skills Experience using/knowledge of Electronic Health Record (EHR) / Electronic Medical Record (EMR) Demonstrated excellent analytical and problem-solving skills, and judgment with specific application to medical and financial data Ability to work in a fast-paced environment while managing and prioritizing multiple, often competing, deadlines and priorities Demonstrated strong attention to detail and capacity to relate to scope of obligations Demonstrated strong time management and organizational skills Demonstrated advanced working knowledge with Microsoft Office applications, including Word, Excel, and Outlook PHYSICAL DEMANDS/ENVIRONMENTAL PROFILE: See Physical Demands Checklist below which represents the general physical demands and environment conditions to which the employee holding this position must meet, in addition to the duties and responsibilities listed above, to successfully perform the essential functions of this job. Elwyn will engage otherwise qualified candidates for this position whose disabilities may require reasonable accommodations to enable an individual to perform the essential functions. Elwyn reserves the right to revise or change job duties and responsibilities as needed. This job description is not meant to be an all-inclusive statement of duties and responsibilities of the job nor does it constitute a written or implied contract. Elwyn is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation and identity, gender identity, national origin, citizenship status, genetic information, disability status, military or veteran status, marital or family status, political activities or affiliations, or any other characteristic protected by local, state, and federal law.

Created: 2024-11-19