Professional Billing Revenue Integrity Manager

MaineHealth; Maine; On-site; USD 70,000 - 110,000; Full time

Job summary

An established industry player in healthcare is seeking a Professional Billing Revenue Integrity Manager to lead a dedicated team in ensuring accurate patient service charges and compliance with billing regulations. This role involves monitoring revenue integrity processes, collaborating with healthcare professionals, and managing complex projects to enhance financial success. Join a supportive environment that values your expertise and offers comprehensive benefits, including parental leave and student loan assistance. If you are passionate about improving healthcare operations and want to make a meaningful impact, we encourage you to apply.

Benefits

Paid parental leave

Flexible work policies

Student loan assistance

Training and education resources

Well-being resources

Qualifications

• 5+ years in Revenue Integrity or Revenue Cycle operations.
• Strong knowledge of medical billing and revenue cycle processes.

Responsibilities

• Oversee daily operations of the PB Revenue Integrity team.
• Collaborate with practice leaders to ensure compliance.

Skills

Revenue Integrity Management

Charge Capture Compliance

Data Analysis

Project Management

Communication Skills

Problem Solving

Education

Bachelor's degree in business or healthcare

8 years of leadership experience in revenue cycle

Tools

MS Office Suite

EPIC HB/PB

Job description

Description

Management/Leadership

Req #: 29708

Summary:

The Professional Billing Revenue Integrity Manager is responsible for overseeing the daily operations of the PB Revenue Integrity team by effectively managing and participating in the team's goals of ensuring patient services are accurately charged, supported by clinical documentation, and that revenue is recorded in the proper practice. The PB Revenue Integrity Manager promotes charging compliance by effectively collaborating with practice leaders and staff. This position operationalizes the PB Revenue Integrity team's strategy and plan by:

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 in business, healthcare, or a closely related field, or eight (8) years of leadership experience within the revenue cycle in lieu of education.
2. License/Certifications: Coding (COC, CPC, CCS, CIC), Clinical (RN), or Revenue cycle (CRCR) certification strongly preferred.
3. Experience: Five (5) years' experience in Revenue Integrity or Revenue Cycle operations within the healthcare industry. Proven proficiency or past experience in charge integrity, charge reconciliation, charge compliance, project and performance management, and productivity measures with performance outcomes.
4. Capacity to review, analyze, and interpret data and analytics to identify root causes and implement corrective actions.
5. EPIC HB/PB experience preferred.
6. Strong knowledge of revenue cycle processes and medical billing, including provider-based, CAH, and RHC considerations. Understanding of billing guidelines and state and federal regulations with impact analysis.
7. Knowledge of code data sets such as CPT/HCPCS, NCCI edits, and Medicare LCD/NCDs.
8. Understanding of reimbursement models including OPPS, HCC, and managed care.
9. Ability to interpret detailed medical records and communicate effectively with physicians, nursing staff, leadership, and billing or coding personnel.
10. Capability to manage large, complex projects, investigate, analyze, and resolve issues independently. Excellent communication, presentation, organizational, analytical, and problem-solving skills.
11. Strong attention to detail, independent problem-solving approach, and ability to work in a fast-paced, collaborative environment.
12. Computer skills: MS Office (Word, PowerPoint, Excel, Outlook), Windows OS, and Internet proficiency.

Additional Information

With a career at any MaineHealth location across Maine and New Hampshire, you'll work with healthcare professionals who value both their colleagues and the communities they serve.

We offer benefits that support your current needs and future planning, including paid parental leave, flexible work policies, student loan assistance, training, education, and well-being resources for you and your family.

MaineHealth is committed to investing in our care team and fostering an inclusive environment where you can thrive and reach your full potential. If you're looking to build a career in a supportive, caring environment, apply today.

If you have questions about this role, please contact Kerry A. Huckins at [e-mail].