Clinical Revenue Integrity Manager - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (E[...]

University of Southern California (USC); Los Angeles (CA); Remote; USD 95,000 - 159,000; Full time

Job summary

An established industry player is seeking a skilled Manager to oversee revenue integrity operations. This pivotal role involves managing charge masters, ensuring compliance, and enhancing operational efficiency across departments. The ideal candidate will have extensive experience in clinical coding and charge management, coupled with strong analytical skills. You will lead efforts to streamline processes, engage collaborators for educational opportunities, and supervise staff to foster a culture of excellence. Join a forward-thinking institution that values your contributions and offers a dynamic environment for professional growth.

Qualifications

• 5-7 years of charge master, clinical coding, and compliance experience required.
• Strong analytical skills and detail orientation are essential.

Responsibilities

• Manage charge master and ensure revenue integrity through accurate charge creation.
• Monitor workflows to mitigate revenue leakages and optimize efficiencies.

Skills

Charge master management

Clinical coding

Compliance knowledge

Analytical skills

Contract management

Revenue cycle management

Detail orientation

Presentation skills

Education

High school diploma or equivalent

Bachelor's degree in business, health administration, or management

Tools

Mainframe hospital accounting systems

Personal computers

Spreadsheets

Job description

Manages the administrative functions and provides operations support to the Department. Responsibilities include developing, monitoring, and providing operational support. Develops, implements, monitors and evaluates administrative procedures, personnel administration, payroll and budget development.

The Manager position will be primarily responsible for overall revenue integrity via the management of the charge master, dictionaries, contract management, EHR management, terms and conditions, and access that foundationally supports all departments and vendors in relation to charging mechanisms and triggers, ensuring clean handoffs between clinical departments and revenue cycle, strategic pricing, denials management. The position must continually keep abreast of regulation changes from all government and other payer updates. Further, the position must lead all respective areas in charge capture and improvements for ensuring the highest level of efficiency, integrity and compliance within our revenue cycle operations. Superior analytical knowledge is a must.

Essential Duties:

• Manage CDMs; Pricing and Fee Schedule; ensure hospital and clinic revenue integrity through charge creation, deletion/changes and continually review for accuracy and compliance.
• Actively manage, maintain and communicate to appropriate collaborators on charge capture, rejection/suspended, denial and improvement activities, trends, and recommended corrective action plans.
• Manage contract management load, audit, and maintenance hospital Health Record system charging related updates, modifications.
• Manage all systems to improve overall change and account net down while working to identify areas for improvement and eliminate rework.
• Manage all systems, access, vendors access and payer sites for efficient and effort work efforts.
• Communicate to team, collaborators stay informed of payer and/or regulatory updates, create action plans to accommodate changes as needed.
• Monitors and manages charging workflows and reports, in coordination with Revenue Cycle and Clinical departments to mitigate revenue leakages and optimize efficiencies.
• Prepares and delivers departmental summaries that pinpoint root causes of charge/billing errors and conceptualize process changes for Revenue Cycle and service line leaders.
• Engage collaborators to facilitate educational and workflow/process opportunities identified by team to improve documentation, charging and clinical operations.
• Continually develop processes, policy procedures and controls to drive revenue integrity.
• Supervises staff, assigns work, and counsels/disciplines if necessary.
• Performs other duties as assigned.

Required Qualifications:

• Req High school or equivalent
• Req Bachelor's degree in business, health administration, or management.
• Req 5-7 years Charge master, clinical coding and compliance knowledge and experience
• Req 2 years Prior supervisory/management experience.
• Req Strong orientation to detail and deadlines.
• Req Clear, concise, and persuasive writing and presentation skills
• Req Knowledge of hospital accounting procedures, managed care, revenue cycle, case management and utilization, patient financial services and reimbursement
• Req Strong skills in mainframe hospital accounting systems; personal computers; and spreadsheets

Preferred Qualifications:

• Pref Specialized/technical training Training Courses in CDM, Strategic Pricing, Billing and Regulatory Compliance, Revenue Cycle preferred
• Pref Cerner Revenue Cycle Experience preferred

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
• Req Certified Coding Specialist - CCS (AHIMA) Active certification as Certified Coding Specialist (CCS), Certified Coding Specialist-Physician Based (CCS-P) (AAPC/AHIMA), or equivalent. If no certification upon hire, one must obtained within 2 years of hire and maintained by renewal before expiration date.

The annual base salary range for this position is $95,680.00 - $158,230.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidates work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.