Provider Revenue Integrity Manager

1200 MH-Memphis Hospitals; Poplar (MT); On-site; USD 110,000 - 135,000; Full time

Job summary

Methodist Le Bonheur Healthcare seeks a Revenue Cycle Manager to plan and implement revenue cycle processes across departments, ensuring compliance and financial impact assessment. The role emphasizes leadership in pricing, denials management, and cross-functional collaboration within a large health system.

The position involves overseeing registration, pre-certification, coding, and charge posting, while maintaining controls and driving process improvements in a high-volume environment.

Qualifications

• Bachelor's Degree in Business Administration/Management required
• High School Diploma or Equivalent preferred
• Master's Degree preferred

Responsibilities

• Plans, organizes, develops and implements revenue cycle operations to meet departmental goals.
• Maintains internal controls over front end billing functions, patient registration, pre-certification, procedure authorizations, insurance verification, charge entry and coding.
• Keeps abreast of reimbursement procedures of third party and private payers.
• Manages patient registration, pre-certification, coding and charge posting, advising supervisors on day-to-day implementation and interpretation for policy compliance.
• Provides analysis on financial impact of new business opportunities and decisions.
• Manages and develops pricing for ULPS products and procedures.
• Oversees re-certification/clinical denials management including appeals, rebilling, and verification.
• Promotes information flow through effective communication within and outside the department.

Job description

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One! We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South. The Provider Revenue Cycle Manager works closely with the Department Managers, Senior Management, Partners Central Billing Office, and other key personnel, to define and implement the resolution of healthcare revenue flow. Responsible for planning and implementing revenue cycle processes. The workload is heavy in volume, and major in regard to financial and compliance impact. Models appropriate behavior as exemplified in MLH Mission, Vision and Values. Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview

The Revenue Cycle Manager works closely with the Department Managers, Senior Management, Partners Central Billing Office, and other key personnel, to define and implement the resolution of healthcare revenue flow. Responsible for planning and implementing revenue cycle processes. The workload is heavy in volume, and major in regard to financial and compliance impact. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do

• Plans, organizes, develops and implements revenue cycle operations to meet UT Le Bonheur Pediatric Specialists and departmental goals and objectives.
• Maintains appropriate internal controls over front end billing functions, patient registration, pre-certification, procedure authorizations, insurance verification, charge entry and coding.
• Keeps abreast of all reimbursement billing procedures of third party and private insurance payers.
• Manages patient registration, pre-certification, procedure authorization, coding, and charge posting, advising supervisors on the day-to-day implementation and interpretation to ensure compliance with all policies and procedures.
• Provides analysis with regard to financial impact of new MH ULPS business opportunities and decisions.
• Manages, and controls development and implementation of product and procedure pricing for ULPS.
• Manages along with the CBO, the re-certification/clinical denials management process including the clinical appeal, rebilling, and verification process.
• Promotes the flow of information by establishing, utilizing, and maintaining effective communication systems within and outside the department.
• Develops, analyzes, and reviews special projects as necessary.
• Manages the process of internal and external charge/chart audit.
• Designs and implements training programs to ensure that all areas are adequately trained on charge capture and reconciliation policies and procedures.
• Designs process to capture lost charges missed by ULPS billing areas to ensure maximum legitimate reimbursement for the services provided.
• Maintains and develops a competent, productive, and quality conscious workforce by hiring, evaluating performance, counseling, training, issuing corrective action, and recommending promotion or discharge of department personnel according to the MH value.

Education/Formal Training Requirements

• Required - Bachelor's Degree Business Administration/Management
• Preferred - High School Diploma or Equivalent
• Preferred - Master's Degree

Work Experience Requirements

• Preferred - Substitutions allowed: In lieu of Bachelor's degree, the candidate must have a High School diploma with four (4) years equivalent experience in business practices, accounting and finance.

Knowledge, Skills and Abilities

• Ability to understand and prepare written materials, such as management reports and memos.
• Ability to communicate verbally with all levels of Associates, senior management officials, and other outside professionals, and demonstrate strong quantitative problem solving abilities.
• Ability to lead and motivate individuals and groups of people toward the accomplishment of work and organizational goals.
• Ability to organize multiple tasks and projects and maintain control of workflow.
• Ability to work without close supervision or guidance and exercise independent judgment.
• Ability to facilitate education/training sessions at all levels of the organization.

Supervision Provided by this Position

Supervises other Supervisors and Associates in the ULPS Revenue Cycle Departments.

Physical Demands

The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion. The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.

The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.

The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently. Occasional travel to other MH entities and customers. Must have good balance and coordination.

Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.

Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. We see each day as a new opportunity to make a difference in the lives of the people in our community.

Within any role at Methodist Le Bonheur, you can play a rewarding and fulfilling part in helping us provide high-quality, innovative and compassionate care to the people of Memphis and the Mid-South.

Our goal is to improve every life we touch, including our Associates.

Because we’re not at our best until you are at yours.