Program Manager - Revenue Integrity

Revenue Cycle Program Managers are experts in the subject matter and possess a comprehensive understanding of Revenue Cycle operations. Program Managers operate independently to analyzes accounts receivable and ensure maximization of net revenue realization, stable cash collections, avoidance of denials and measured reduction to bad debt. Program Managers act as liaisons between central billing offices, facilities, and other stakeholders.

The Revenue Integrity Program Manager serves as a leader and subject matter expert for revenue integrity operations by optimizing revenue, supporting clinical and other colleagues in optimizing accurate charge capture, interpreting government regulations and payer requirements, and maintaining the chargemaster. The Revenue Integrity Program Manager oversees projects, implements best practices, educates users on processes and vendor products, and recommends actionable improvements. Revenue Integrity Program Managers also serve as a liaison to the Central Business Offices and facilities to support continuous process improvement and compliant revenue maximization.

Key responsibilities include:

• Monitors, reads, interprets, and disseminates regulatory and payer requirements to identified parties timely through the creation of communications, trainings, and policies
• Performs and/or coordinates revenue integrity audits to verify adherence to policy, regulatory guidance and industry standards, analyzes audit findings to create action plans, and coordinates efforts for remediation as needed
• Supports the implementation and maintenance of revenue cycle management software and tools based on end user requests and regulatory guidance
• Communicates CDM maintenance activities to clinical departments and information systems staff to implement necessary changes that affect charge identification, capture, reconciliation, and claim processing
• Responds to internal and external audit requests in a timely manner
• Provide guidance, coaching, and mentorship to junior team members
• Generates reports related to revenue cycle metrics, such as CDM accuracy, charge capture, claim denials, write-offs, and payment delays, and assist in analyzing trends
• Performs all other duties as assigned/required

Qualifications

Experience & Knowledge: A Revenue Cycle Program Manager should have a minimum of 8-10 years of relevant experience and a college degree in business, finance, healthcare administration, health information management, or similar. A Program Manager should have demonstrated experience working in a patient accounting system, coordinating diverse stakeholders, improving Revenue Cycle operations, and utilizing pattern analytics and industry best practices to enhance systems and operations. A highly qualified candidate should have experience with healthcare compliance, health information, inpatient medical billing and coding, and healthcare regulatory operations. Medical coding certification (e.g., CPC, CCS) is strongly preferred. Significant Revenue Cycle experience (i.e., 5+ years in addition to the minimum) might be accepted in lieu of certain college education requirements. A qualified candidate should have strong professional written and verbal communication skills, proficiencies in Microsoft Office tools (e.g., Word, Excel, etc.), and the ability to meet deadlines and multitask.

Travel Requirements: Up to 15% domestic travel dependent on business need