Manager - Revenue Integrity Operations

MaineHealth; Scarborough (ME); On-site; USD 83,000 - 113,000; Full time

Benefits offered by this job

Paid parental leave

Flexible work options

Student loan assistance

Professional development opportunities

Well-being resources

Job summary

MaineHealth seeks a Revenue Integrity Manager to lead a multidisciplinary team focused on improving charge capture, coding accuracy, and overall reimbursement across the health system.

The role requires 7–10 years in revenue cycle leadership, CPC/COC/CCS certifications, and strong data analytics, with collaboration across clinical and billing teams to drive performance and compliance.

Qualifications

• Bachelor's degree in business, healthcare or closely related field or 7–10 years of leadership in revenue cycle.
• COC, CPC or CCS certification required or to be obtained within 6 months.
• 7–10 years hospital revenue cycle management experience with leadership responsibilities.
• Extensive knowledge of CPT, HCPCS, ICD-10, NCCI and Medicare LCD/NCDs.
• Strong communication, analytics, project management and problem-solving skills.

Responsibilities

• Lead Revenue Integrity initiatives to strengthen charge capture and regulatory compliance.
• Monitor revenue integrity processes, productivity metrics and staff functions.
• Collaborate with clinical departments and billing personnel to ensure accurate charging.
• Drive projects related to charge capture and financial performance.

Skills

COC certification

CPC certification

CCS certification

Charge integrity

Data analytics

Project management

Communication skills

EPIC HB/PB experience

Education

Bachelor's degree in business or healthcare

Tools

MS Office

EPIC HB/PB

Job description

Description

MaineHealth Corporate

Management/Leadership
Req #: 92097

Summary:
This position contributes and supports Revenue Integrity's Mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and charge improvement process. It is a holistic approach that guides the MaineHealth organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. * * Under the direction of the Director of Revenue Integrity, the Revenue Integrity Manager plays an important role in a high-profile group tasked with improving revenue results. This position is integral to the Revenue Integrity Team to assist in ensuring patient services are accurately charged, appropriately coded, supported by clinical documentation and that the related revenue is recorded in the proper department. In turn, this promotes revenue enhancement and compliance with laws and regulations with feedback and education to the hospital departments as needed.

This position maximizes efficiency through 1) monitoring and supporting revenue integrity processes, productivity measures and staff functions; 2) aiding in ensuring the accuracy and integrity of the revenue charge capture across the health system; 3) collaborating with team members to steer projects related to charge capture for financial success.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: Bachelor's degree from a recognized college or university in business, healthcare or a closely related field or seven to ten (7-10) years of supervisory and/or leadership experience within the revenue cycle in lieu of education.
2. License/Certifications: COC, CPC, CCS certification required, or must obtain within 6 months of employment to the position.
3. Experience: Seven to ten (7-10) years' experience in the hospital setting, healthcare industry with proven proficiency or past experience in a management position in the following areas: charge integrity; charge reconciliation; charge compliance; project and performance management, productivity measures with performance outcomes. Capacity to review, analyze and interpret data and analytics to root cause and implement corrective action. EPIC HB/PB experience preferred.
4. Proficiencies: Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM, UB, RAs and 1500. Extensive knowledge of code data sets to include CPT, HCPCS, and ICD 10. Extensive knowledge of NCCI edits, and Medicare LCD/NCDs. Extensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Strong understanding of billing guidelines and state and federal regulations with impact analysis. Ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership and other billing or coding personnel.
5. Abilities: Requires the ability to manage large complex projects assignments, investigate, analyze and resolve issues at a high level. Excellent communication, presentation, organizational, analytical and problem solving skills. Must approach problem solving challenges independently, have strong attention to detail and enjoy working in a fast paced, collaborative team based environment. Computer skills - MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.

Additional Information

MaineHealth is committed to fostering a supportive, inclusive environment where care team members can thrive while making a meaningful impact in the communities we serve across Maine and New Hampshire. We offer competitive benefits including paid parental leave, flexible work options, student loan assistance, professional development opportunities, and well-being resources-so you can grow your career while feeling supported both personally and professionally.

We recognize the value each team member brings to our organization.Any offer of employmentwill depend onqualificationssuch asskills, relevant experience, education, certifications,and otherjob-relatedfactors. Thebase rangeis an estimate and does notreflect the full valueofourtotal compensationpackage.

The pay range for this position is $83,324.80to $112,736.00per year.

Compensation for part-time positions isdeterminedon a prorated basis consistent with the scheduled hours and applicable full-time equivalent (FTE).

In addition to base pay, MaineHealth offerscomprehensivebenefits, recognition programs, career growth opportunities, and,where applicable,shiftdifferentials or other incentives.

If you have questions about this role, please contact [e-mail]