Manager Revenue Integrity Job

Children's Health - Finance Careers

Job Number: 53901

Location: Dallas, TX

Date Posted: 4-11-2018

Description:

POSITION SUMMARY:

Oversees professional staff responsible for managing, coordinating, and implementing Charge Description Master (“CDM”) and charge capture initiatives and processes to ensure revenue management and revenue protection. Facilitates CDM and charge capture education; ensures adherence to government/non-government regulatory directives; ensures appropriate levels of control are established to satisfy audit/review requirements; and facilitates revenue management communications and information flow.

JOB PROFILE:

The following describes the basic position duties that an employee MUST be able to perform for this role. This information is intended to be descriptive of the key responsibilities of the position. The list of essential functions below DOES NOT identify all duties performed by any single person in the position.

Typically manages professional staff and/or team leaders over multiple teams

Typical span of control: Administrative 8-10, Clinical 10-13, Support Services 11-13; e.g. Admin: Fin, IT, Legal, HR, Public Affairs; Support Services: EVS, Security, Engineering, Food Services.

Accountable for the performance and results of a team or multiple teams within own discipline

Adapts unit plans and priorities to address resource and operational challenges

Provides guidance, coaching, and feedback to team leaders on effective management techniques

Makes employment decisions for the team, seeking direction from more senior leaders on more complex situations

Decisions are guided by policies, procedures, and functional priorities; receives guidance from a higher-level manager on high-impact decisions

Monitors quality metrics and changes in practice that impact clinical, financial, or operational outcomes and develops action plans to address areas for improvement

Provides guidance to others as needed for non-routine and/or complex problems/situations

Monitors and manages a budget for defined area of responsibility

JOB SPECIFIC RESPONSIBILITIES:

Oversees maintenance of accurate and timely patient accounting system(s) changes/updates to sustain data integrity and to facilitate claims processing; ensures quality reviews occur to identify and minimize system errors.

Plans revenue management strategies as identified in data/report analyses to ensure consistency/standardization, to identify improvement opportunities, and to facilitate appropriate knowledge transfer.

Oversees maintenance of accurate and timely patient accounting system(s) changes/updates to sustain data integrity and to facilitate claims processing; ensures quality reviews occur to identify and minimize system errors.

Define problems, collect data, establish facts, draw valid conclusions, and make recommendations for improvement

Read, review, analyze, and interpret a variety of state/federal regulatory information and managed care contracts and the affect on appropriate claims production, clinical/order entry systems, ancillary systems, and CDM

Utilize and research various published resources, appropriate reference materials, Internet resources, seminars, and other associated information sources to continually stay abreast of changes in regulatory information

Serves as a resource to all service lines as well as revenue cycle works closely and collaboratively with all departments

Manages a professional team to evaluate, review, plan, implement, and report various revenue management strategies to ensure CDM integrity; to identify improvement opportunities; and to facilitate appropriate education

Evaluates and maintains workflow processes to ensure efficiencies; works with all personnel involved in the revenue cycle to optimize CDM interfaces and processes

Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact and to ensure optimal revenue management; continually reviews and monitors billing and coding changes affecting CDM and charge capture processes to ensure accurate claims production, appropriate distribution of information, and to identify target areas for education

Provides incident management and problem resolution; views incidents and problems from a systemic perspective to determine system-wide solutions; oversees implementation of recommendations and monitors results to prevent recurrence; investigates complex issues as required

Manages implementation of CDM and/or charge capture corrective measures and monitoring tools to ensure sustainability of changes; reviews and monitors statistics and key performance indicators to identify improvement opportunities and ensure compliance with regulatory/non-regulatory directives

Oversees pricing initiatives such as strategic pricing, across-the-board increases, tiered pricing, pricing transparency; conducts interim pricing reviews and performs financial analyses for strategic initiatives

Manages/oversees special projects and special studies as required for new clients, system conversions, acquisitions, new departments, new service lines, changes in regulations, legal reviews, etc.

EXPERIENCE:

Minimum of five years healthcare-related experience required

Prior healthcare financial experience or related field experience in a hospital/integrated healthcare delivery system required

EDUCATION:

Four-year Bachelor's degree or equivalent experience required

Graduate or professional work or advanced degree; or equivalent experience preferred

Specific Knowledge, Skills and Abilities:

Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.

Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.

Develop and use collaborative relationships to facilitate the accomplishment of work goals.

Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.

Provide feedback, instruction, and development guidance to help others excel in their current or future job responsibilities; plan and support the development of individual skills and abilities.

Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.

Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.

Effectively manage one's time and resources to ensure that work is completed efficiently.

Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.

Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self-impose standards of excellence rather than having standards imposed.

Assimilate and apply new job-related information in a timely manner.

Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.

LICENSES and CERTIFICATIONS:

Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, CPC-H, CCS Preferred


Back to top