Manager, Revenue Integrity (Full-Time, 40, Day)

The Queen's Health Systems; Honolulu (HI); On-site; USD 120,000 - 150,000; Full time

Job summary

The Queen’s Health Systems seeks a senior leader to oversee revenue cycle processes and protect financial integrity across its facilities. You will direct contract negotiations, analyze complex financial data and drive improvements in reimbursement strategies.

Ideal candidates bring 5+ years in revenue cycle with governance, compliance and payer relationships, plus leadership experience guiding teams and strategic initiatives within a healthcare system.

Qualifications

• Bachelor's degree in Business Administration, Finance or Health Care Administration; or four (4) years experience in revenue cycle or finance may be substituted.
• Master's degree preferred.
• No certification and/or licensure requirement.
• Five (5) years experience in revenue cycle, including revenue integrity, charge capture, compliance, pricing and reimbursement.
• Two (2) years supervisory/leadership experience.
• Knowledge of contracts, financial analysis methods, accounting principles and health care delivery systems.
• Knowledge of requirements specific to government-funded health care program and third party payer reimbursement.
• Prior experience in healthcare insurance provider contract negotiations experience preferred.

Responsibilities

• Oversees, manages and evaluates clinical and financial processes to improve revenue results, ensures integrity, and safeguards The Queen’s Health Systems (QHS) medical facilities against exposure and penalties.
• Provides leadership and oversight in the accomplishment of organizational goals and objectives related to revenue integrity, managed care contracts, government reimbursement activities, and QHS Charge Description Masters (CDM).
• Prepares and presents financial reports for executive management review.
• Manages and directs the development and implementation of new and existing managed care contracts.
• Provides oversight over existing managed care contracts to ensure compliance and optimal financial and operational performance.
• Develops, manages and sustains relationships with third party payers and other external contacts.

Skills

Revenue cycle

Revenue integrity

Contract negotiations

Financial analysis

Leadership

Education

Bachelor's degree in business/finance/health care admin

Master's degree preferred

Job description

RESPONSIBILITIES

I. JOB SUMMARY:

• Oversees, manages and evaluates clinical and financial processes to improve revenue results, ensures integrity, and safeguards The Queen’s Health Systems (QHS) medical facilities against exposure and penalties.
• Provides leadership and oversight in the accomplishment of organizational goals and objectives related to revenue integrity, managed care contracts, government reimbursement activities, and QHS Charge Description Masters (CDM).
• Prepares and presents financial reports for executive management review.
• Manages and directs the development and implementation of new and existing managed care contracts.
• Provides oversight over existing managed care contracts to ensure compliance and optimal financial and operational performance.
• Develops, manages and sustains relationships with third party payers and other external contacts.

II. TYPICAL PHYSICAL DEMANDS:

A. ESSENTIAL FUNCTIONS:

• Seeing.
• Hearing.
• Speaking.
• Finger dexterity.

B. MANUAL MATERIAL HANDLING:

• Infrequent: N/A
• Occasional: Lift waist to shoulder between 0-5 lbs. Carry between 0-5 lbs.
• Frequent: N/A
• Constant: N/A

C. NON-MANUAL MATERIAL HANDLING:

• Infrequent: N/A
• Occasional: Stand. Walk. Stoop/Bend. Climb: Stairs/Ladder. Reach: shoulder level.
• Frequent: N/A
• Constant: Sit.

III. TYPICAL WORKING CONDITIONS:

• Not substantially subjected to adverse environmental conditions.

IV. MINIMUM QUALIFICATIONS:

A. EDUCATION:

• Bachelor's degree in Business Administration, Finance or Health Care Administration; or four (4) years experience in revenue cycle or finance may be substituted for the educational requirement.
• Master's degree preferred.

B. CERTIFICATION AND LICENSURE:

• No certification and/or licensure requirement.

C. EXPERIENCE:

• Five (5) years experience in revenue cycle, including revenue integrity, charge capture, compliance, pricing and reimbursement, preferably in a comparable organization.
• Two (2) years supervisory/leadership experience.
• Experience to demonstrate:
• Knowledge of contracts, financial analysis methods, accounting principles and health care delivery systems.
• Knowledge of requirements specific to government-funded health care program and third party payer reimbursement.
• Prior experience in healthcare insurance provider contract negotiations experience preferred.

Equal Opportunity Employer/Disability/Vet