Manager of Revenue Integrity and CDM
- Location: Boston, MA
- Posted: Sep 28, 2018
The Manager of Revenue Integrity and the Charge Description Master is responsible for supporting the enhancement and maintenance of properly functioning revenue cycle processes Tufts Medical Center as well as ensuring the integrity of the revenue charge capture system. In addition to supporting efficient revenue cycle functions, this individual assists with the management of a clinically driven revenue cycle review process to achieve a high standard of clinical quality while contributing to the organization's overall financial performance.
This position maximizes efficiency through 1) monitoring and supporting revenue cycle processes and staff functions; 2) aiding in ensuring the accuracy and integrity of the revenue charge capture system; 3) Managing the Charge Description Master.
Manages multiple revenue cycle initiatives across the organization to improve processes and support optimal revenue cycle performance.
Oversees the revenue charge capture system to promote its accuracy and integrity across revenue- generating departments of the organization.
Works with department managers to help develop and implement policies and procedures for the purposes of reconciling charges posted in the billing system with other source information.
Manages a Revenue Integrity team that identifies opportunities for charge capture improvement by implementing and analyzing the results of routine, random audits.
Develops tools for the purposes of tracking and identifying potential areas of lost revenue.
Educates staff regarding the appropriate application of CCI, medical necessity, etc. edits.
Helps maintain and enhance the chargemaster; reviews organizational charge structures to assure that charges accurately reflect services and supplies provided and are consistent with current industry best practices.
Develops and provides reports to the Director of Health Information Management, CDM and other clinical leadership as required.
Works closely with Nthrive, Tufts Medical Center Information Systems, Finance and clinical departments to assure high quality data.
Educates staff on Nthrive and the ChargeMaster database as needed.
Reviews changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable billing guidelines and optimization of reimbursement.
Ensures staff members are knowledgeable about documentation needs and coding and reimbursement issues identified through documentation reviews and aggregate data analysis.
Summarizes performance gaps and priority "opportunities for improvement".
Trains individuals for independent data base use.
Monitors disparity outcomes and reports findings to appropriate Clinics/Departments.
Makes informed recommendations on purchase of software and hardware, taking into account statistical analysis, database and data entry needs and future projected system capacity needs.
Maintains collaborative, positive team relationships with peers and colleagues in order to effectively contribute to the working groups achievement of goals, and to help foster a positive work environment.
Performs other similar and related duties as required or directed. Reports to Director of Health Information Management.
Works with personnel of various levels within and outside Tufts Medical Center as directed.
Bachelor's degree in business, health or public administration, management, or a related field required.
5+ years of experience working in health care field where position required database management.
At least 3 years of experience in managing healthcare business functions.
Revenue and clinical quality continues to meet or surpass organization/industry standards.
Revenue cycle functions are completed with a high degree of quality and accuracy, and all interactions with staff are handled in a positive manner.
Knowledge of relational databases, report writing, and presentation software packages.
Ability to present complex data and concepts to leadership, and other clinical and administrative leaders within the Tufts Medical Center community.
Experience within an academic medical center preferred.
Knowledge of statistics and research methodologies.
Working understanding of quality improvement and process improvement methodologies.
Extensive knowledge of current healthcare trends, policies, and regulations. Understanding of coding classifications systems such as, but not limited to, ICD-10-CM, CPT and HCPCS codes strongly preferred.
Competency in developing efficient and effective solutions to complex business challenges.
Strong leadership skills and commitment to a team approach.
Ability to influence key stakeholders at various organizational levels.
Comprehensive understanding of computer, database, and network technologies.
Exceptional verbal, interpersonal, and written communication skills.
Analytical skills needed to work independently with databases, manage budgets, develop policies and procedures, perform appropriate statistical analyses, etc.
- Full Time