Revenue Integrity Manager

KAVI Philippines; Philippines; Presencial; PHP 1 800 000 - 3 000 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Competitive compensation

Career growth opportunities

Team-oriented culture

Employee engagement activities

Resumo da oferta

Kavi Philippines is seeking a Revenue Integrity Manager to lead charge capture, coding compliance, and reimbursement optimization across healthcare services. You will collaborate with clinical, coding, billing, finance, and IT teams to prevent revenue leakage and improve revenue cycle performance.

The ideal candidate has strong healthcare revenue cycle expertise, analytical capabilities, and leadership experience in revenue integrity, charge capture, coding, and reimbursement optimization.

Qualificações

• Must have 5–7+ years in healthcare revenue cycle management, revenue integrity, charge capture, coding, billing, or reimbursement.
• At least 2–3 years in a team leadership or management role.
• Experience with US hospitals/health systems or RCM providers preferred.

Responsabilidades

• Oversee charge capture processes to ensure all eligible services are documented, coded, and billed.
• Manage and maintain the Charge Description Master (CDM) with updates.
• Identify revenue leakage and under/overbilling through audits.
• Establish controls to improve charge accuracy across departments.
• Collaborate with clinical and operational teams to resolve discrepancies.
• Ensure CMS regulations, payer policies, and coding guidelines are followed; conduct audits and implement corrective actions.
• Support audits and maintain documentation; improve denial management and reimbursement accuracy.
• Develop dashboards and KPIs to monitor revenue integrity performance.
• Collaborate with Coding, Billing, Clinical Operations, Finance, Compliance, Contracting, and IT teams.
• Lead and develop revenue integrity professionals; drive continuous improvement.

Conhecimentos

Leadership

Revenue cycle management

Analytical skills

Regulatory compliance

Cross-functional collaboration

Formação académica

Bachelor's degree in Healthcare Administration

CPC

CCS

CPMA

RHIA

CRCR

Descrição da oferta de emprego

The Revenue Integrity Manager is responsible for ensuring accurate charge capture, coding compliance, billing accuracy, and optimal reimbursement across healthcare services. This role focuses on identifying and preventing revenue leakage, improving revenue cycle performance, maintaining regulatory compliance, and implementing process improvements through collaboration with clinical, coding, billing, finance, and IT teams.

The ideal candidate will have strong healthcare revenue cycle expertise, analytical capabilities, and leadership experience in revenue integrity, charge capture, coding, and reimbursement optimization.

Regulatory Compliance

Compliance Reviews

Administrative Work

Technical Expertise

Key Responsibilities

A. Revenue Integrity and Charge Capture

Oversee charge capture processes to ensure all eligible healthcare services are accurately documented, coded, and billed.

Manage and maintain the Charge Description Master (CDM), including charge descriptions, codes, and reimbursement-related updates.

Identify revenue leakage, missed charges, underbilling, and overbilling through systematic reviews and audits.

Establish controls to improve charge accuracy, completeness, and consistency across departments.

Partner with clinical and operational teams to resolve charge capture discrepancies.

B. Coding, Billing, and Regulatory Compliance

Ensure compliance with applicable CMS regulations, payer policies, and coding guidelines, including CPT, HCPCS, and ICD-10-CM.

Conduct periodic audits of coding, billing, and charge capture processes to identify compliance risks.

Develop corrective action plans to address audit findings and recurring billing errors.

Collaborate with compliance and coding teams to implement regulatory and reimbursement policy updates.

Support internal and external audits and maintain appropriate documentation.

C. Denial Management and Reimbursement Optimization

Analyze denial trends, underpayments, billing discrepancies, and reimbursement variances.

Identify root causes of revenue loss and implement sustainable corrective actions.

Collaborate with denial management, accounts receivable, and payment posting teams to resolve reimbursement issues.

Support payer contract compliance reviews and investigate reimbursement discrepancies.

Recommend process improvements to minimize avoidable denials and maximize appropriate reimbursement.

D. Data Analytics and Performance Management

Develop dashboards and reports to monitor revenue integrity performance.

Establish and track key performance indicators (KPIs), including:

Charge capture accuracy and completeness.

Revenue leakage and missed-charge trends.

Coding and billing accuracy.

Denial rates attributable to charge or coding errors.

Underpayment identification and recovery.

Audit compliance and corrective action closure.

Use data analytics to identify trends, operational risks, and opportunities for improvement.

Present performance insights and improvement recommendations to senior leadership.

E. Cross-Functional Collaboration

Work closely with Coding, Billing, Clinical Operations, Finance, Compliance, Contracting, and IT teams.

Partner with EHR and billing system teams to improve charge workflows, system configurations, and billing edits.

Support the implementation of new reimbursement policies, coding updates, and technology solutions.

Facilitate regular operational reviews to resolve issues and improve revenue cycle outcomes.

F. Team Leadership and Process Improvement

Lead, mentor, and develop revenue integrity professionals.

Establish performance expectations, quality standards, and productivity targets.

Conduct regular performance reviews and provide coaching and training.

Standardize workflows, audit methodologies, and operating procedures.

Drive continuous improvement initiatives to improve efficiency, accuracy, compliance, and financial outcomes.

Must have:

• Bachelor's degree in Healthcare Administration, Health Information Management, Healthcare Finance, Business Administration, or a related field.
• 5–7+ years of experience in healthcare revenue cycle management, revenue integrity, charge capture, coding, billing, or reimbursement.
• At least 2–3 years of experience in a team leadership or management role.
• Demonstrated experience in revenue integrity audits, charge reconciliation, coding compliance, and reimbursement analysis.
• Experience working with US hospitals, health systems, physician groups, or healthcare RCM service providers is preferred.
• One or more of the following certifications are preferred:

• Certified Professional Coder (CPC).
• Certified Coding Specialist (CCS).
• Certified Professional Medical Auditor (CPMA).
• Registered Health Information Administrator (RHIA).
• HFMA Certified Revenue Cycle Representative (CRCR).

Nice to have:

• Experience supporting US healthcare providers, including hospitals, health systems, and physician practices.
• Familiarity with Medicare, Medicaid, and commercial payer reimbursement policies.
• Experience with hospital or professional billing revenue integrity.
• Exposure to revenue cycle analytics, automation, and AI-enabled audit solutions.
• Experience leading cross-functional improvement initiatives in a multi-site or global delivery environment.
• A relevant master's degree is preferred but not mandatory.

What's great in the job?

• Strong Communication Development– Improve your professional English communication through daily calls and coordination.
• Structured Training & Support– Learn industry-standard processes with guidance from experienced team members.
• Career Growth Opportunities– Build a solid foundation for long-term growth in the healthcare BPO industry.
• Team-Oriented Environment– Work closely with supportive colleagues in the TES team.

What We Offer

At Kavi Philippines, every employee has the opportunity to make a meaningful impact. We foster a collaborative environment where ideas are valued, contributions are recognized, and professional growth is encouraged. Clearpathways for professional development and advancement.

We believe in investing in our people through continuous learning, career development, and a supportive workplace culture.

Competitive Compensation

Attractive salary package and benefits.

Clear pathways for professional development and advancem

Join a team of talented professionals in a supportive culture that encourages collaboration, recognizes contributions, and values work-life balance.

Employee Engagement Activities

Team-building activities, company events, and employee recognition programs.