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JOB SUMMARY
The Manager of Revenue Integrity performs duties of moderate to high complexity, judgement, and scope under the direction of the Baylor Scott & White Health’s (BSWH) Director of Revenue Integrity.
This position is responsible for the oversight of a team that ensures that the Charge Description Master (CDM) and hospital and professional charge capture methodologies and workflows are compliant with Federal, State, and third-party payor guidelines and requirements.
The Manager of Revenue Integrity is responsible for the planning and implementation of charge capture and charge reconciliation audit programs, developing work teams, assigning tasks, and coordinating departmental projects, workflow, training and development of staff, and assisting in managing the departmental budget.
ESSENTIAL FUNCTIONS OF THE ROLE
• Collaborates with the BSWH Director of Revenue Integrity to develop department strategy, structure, productivity standards/metrics, applicable policies and procedures, etc.
• Responsible for hiring, training, developing, and evaluating assigned direct reports and provides ongoing oversight and support to direct reports and assigned service lines.
• Serves as the definitive resource and point of contact to provide guidance and advice regarding the Charge Description Master (CDM) and charge capture related topics throughout the System to all BSWH key stakeholders.
• Partners with other Revenue Cycle, clinical, and Information Services departments to identify, research, and resolve charge capture issues. Maintains knowledge of all charge capture methodologies, workflows, and processes for assigned service lines.
• Shares ownership in the development of the Revenue Integrity Audit Program annually in collaboration with the Director of Revenue Integrity.
• Evaluates charge capture workflows across all service lines and identifies areas of risk for inclusion in the audit program.
• Establishes scope, schedules, and timeline, assigns responsibilities, drafts/edits audit reports, and presents findings to applicable department, facility, and system leadership.
• Responsible for ensuring the accuracy of all key data elements of the Charge Description Master (CDM) and remains updated with all government and commercial payor coding and regulation changes through a system-wide CDM program.
• Assists with establishing and implementing CDM-related policies and procedures including an annual CDM Audit program.
• Serves as an internal resource to inform and consult with departments when regulatory changes occur to ensure ongoing charge capture and CDM compliance.
• Develops strategy for performing CDM and charge capture education and assists direct reports with providing education to key stakeholders.
• Supports new department, facility, and service implementations for the Revenue Cycle to ensure charge capture is performed accurately, consistently, and compliantly by serving as a project manager, reviewing regulations, designing and reviewing charge capture workflow build, and ensuring post-go-live charge capture audits are performed and identified issues are mitigated.
• Develops and maintains workflows to support the BSWH Charge Reconciliation policy and procedure across all revenue generating departments.
• Responsible for ensuring frequent and consistent Charge Reconciliation training and education is provided to department leaders.
• Establishes and executes a Charge Reconciliation audit program in line with the larger Revenue Integrity Audit program.
• Performs other position appropriate duties as required in a competent, professional, and courteous manner.
KEY SUCCESS FACTORS
• Exceptional verbal and written communication skills, manifesting in the ability to create and edit executive-ready communications that are informative, concise, and free of spelling and grammatical errors and which inspire engagement and participation from individuals at all levels of the organization.
• The ability to effectively manage multiple high-priority and high-visibility projects simultaneously, including informal leadership of projects not directly within the scope of responsibility.
• Ability to oversee and execute complex tasks through an organized and detail-driven approach, to problem-solve, and to predict and mitigate up- and down-stream implications of actions, as well as long-term viability of a plan(s).
• Advanced knowledge of Excel and data analytics to include formulas, functions, and pivot tables in order to analyze large data sets, draw conclusions, and make and implement decisions.
• Ability to work independently and as a part of a team in a fast-paced, unpredictable, and deadline-driven environment while also managing a team of high-achieving professionals.
• Self-motivated with ability to proactively identify and resolve issues and advance personal knowledge.
• Ability to provide leadership and guidance to direct reports, supporting growth and personal development while ensuring department objectives are accomplished.
• Exceptional organizational skills.
• Adept in researching complex questions, providing recommendations, making decisions, and devising strategies to ensure appropriate outcomes.
• Maintains knowledge of Revenue Codes and CPT/HCPCS coding methodologies and has a comprehensive knowledge of healthcare billing, finance, and reimbursement.
• Revenue Cycle/ Revenue Integrity experience preferred.
• Epic Hospital Billing, Professional Billing, and Charge master experience preferred.
BENEFITS
Our competitive benefits package includes the following
• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1
• Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
• EDUCATION – Bachelor’s
• EXPERIENCE – 3 Years of Experience
