Manager, Revenue Integrity

Overview:

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The Manager, Revenue Integrity is responsible for identifying and developing strategies which will optimize reimbursement across the Yale New Haven Health System. With support from key areas throughout the Delivery Networks, this position will recommend and coordinate implementation of process improvements, revenue enhancement initiatives for the revenue cycle, and educating departments, clinicians and revenue cycle participants on coding, billing and reimbursement regulations to ensure appropriate reimbursement in a compliant manner.

EEO/AA/Disability/Veteran

Responsibilities:

• Manage system charge capture / nurse audit teams, on all projects and assignments.
• Manage an enhanced business practice model that supports appropriate reimbursement and compliant charge capture processes.
• Improve systems net revenues, revenue compliance and cash collections by optimizing the system wide revenue cycle. Lead the team to ensure revenue, billing, charging and coding compliance through education of hospital personnel on current and changing regulations.
• Work collaboratively with the Charge Description Master Manger to ensure CDM is updated to reflect appropriate coding and billing guidelines as well current insurance contracts.
• Participate collaboratively with System Billing Office, EPIC HB, and Denials Management teams in the development, execution and follow-up of education programs for the healthcare system on all issues related to the revenue cycle.
• Develop and maintain collaborative working relationships with revenue producing departments, information systems personnel and clinical services.
• Act as a liaison between clinical and finance departments when new service lines are created or regulations are updated that affect current service lines.
• Perform on-site analysis of processes and Revenue Cycle Management as well as conducting follow up analysis of post-implementation operations.
• Perform charge capture audits.
• Identify root causes of charging practices and deficiencies to effectively address changes needed.
• Perform defense audits upon notification of external governmental audits.
• Follow up on issues uncovered during internal or external audits.
• Provide coding expertise for all compliance and reimbursement issues.
• Maintain up-to-date knowledge of regulatory (federal, state, and third party payer) requirements and changes impacting charging practices.
• Perform all other duties as assigned.

Qualifications:

EDUCATION

• Bachelor's degree in Finance, IT or related field is required. Master's Degree preferred.

EXPERIENCE

• A minimum of 5 years of progressive experience working in a Revenue, Billing and/or Finance discipline within a healthcare setting.

LICENSURE

• RN License, Coding Certification or Epic Resolute Certification preferred.

SPECIAL SKILLS

• Excellent verbal and written communications skills.
• Strong computer skill with the ability to work independently and meet crucial deadlines.
• Ability to perform multiple tasks within time frame.
• Excellent interpersonal skills with the ability to relate well, communicate effectively, and interact with all levels of management, employees and outsiders.
• Strong analytical and interpretive skills.
• Current knowledge of reimbursement requirements necessary for Third Party payers including Medicare, Medicaid, and Commercial plans.
• Knowledge of medical coding, billing and Federal/State regulations.