Manager of Revenue Integrity Compliance

Prime Healthcare; Ontario; On-site; USD 97,000 - 142,000; Full time

Job summary

A leading healthcare provider is seeking a Manager of Revenue Integrity Compliance to lead compliance initiatives and manage the revenue integrity plan. This role requires strong leadership and a detailed understanding of healthcare revenue cycles. The ideal candidate has over 7 years of experience in the field and is skilled in regulatory compliance and process improvement. This is a full-time position offering competitive pay and benefits.

Benefits

Competitive pay

401K

Medical/dental/vision coverage

Tuition reimbursement

Paid time off

Qualifications

• At least 7 years of experience in healthcare revenue cycle operations.
• At least 3 years in leading a revenue cycle function.
• Experience interpreting claim forms and remittances.

Responsibilities

• Develop and manage the Revenue Integrity & CDM Compliance Plan.
• Ensure compliance with CMS Price Transparency Rule.
• Collaborate with multiple teams to streamline compliance processes.

Skills

Healthcare revenue cycle operations

Leadership

Collaboration

Regulatory compliance

Data analysis

Education

Bachelor’s degree in Healthcare Administration, Finance, or related field

Tools

EPIC

Meditech

Job description

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Prime Healthcare is an award-winning health system headquartered in Ontario, California. It operates 51 hospitals and over 360 outpatient locations across 14 states, providing more than 2.5 million patient visits annually. With nearly 57,000 employees and physicians, it is one of the nation's leading health systems. Eighteen of its hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new team members!

Responsibilities

The Revenue Integrity Compliance Manager is a highly motivated, detail-oriented professional responsible for leading and overseeing the organization’s Revenue Integrity and Charge Description Master (CDM) compliance initiatives. This role ensures adherence to CMS Price Transparency Rule and other federal and state financial reporting requirements. The manager should be a strategic thinker with strong leadership and collaborative skills.

Key Responsibilities

• Develop, implement, and manage the Revenue Integrity & CDM Compliance Plan.
• Ensure compliance with CMS Price Transparency Rule and other applicable regulations.
• Collaborate with teams including Health Plan Operations, Patient Access, Marketing, IT, and Legal to streamline compliance processes.
• Design and execute audit plans for compliance reporting.
• Coordinate with hospital end users and offshore teams for accurate and timely deliverables.
• Lead the development of process automation tools to improve compliance efficiency.
• Generate and distribute compliance reports to stakeholders.
• Monitor regulatory changes and update policies accordingly.

Qualifications

Required:

• Bachelor’s degree in Healthcare Administration, Finance, or related field (or equivalent experience).
• At least 7 years of experience in healthcare revenue cycle operations.
• At least 3 years in leading a revenue cycle function.
• Experience interpreting claim forms and remittances.
• Understanding of patient insurance benefits and working with payers like Medicare, Medicaid, and commercial insurers.
• Knowledge of CPT, HCPCS, Diagnosis codes, DRG, EAPG, revenue codes, etc.
• Understanding of payor payment methods such as Fee Schedule, RCC, and Case rate.

Preferred:

• Experience with Contract Management and Patient Access.
• Experience with EPIC and Meditech systems.

Additional Information

Prime Healthcare offers competitive pay and benefits, including paid time off, 401K, medical/dental/vision coverage, tuition reimbursement, and more. The estimated annual compensation range for this role in California is $97,760 - $141,440, depending on experience and qualifications. Exact salary will be determined at hire.

Employment Details

Full-Time, Day shift.

Equal Opportunity

Prime Healthcare is an equal employment opportunity employer. We prohibit discrimination based on race, color, sex, sexual orientation, gender identity, religion, national origin, age, disability, military status, genetic information, or other protected categories. For more information, visit: Know Your Rights.

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