Revenue Integrity Manager

  • Location: Plymouth, MA
  • Posted: Sep 18, 2019

Job Description

**This position is part of our Community One project and will support 3 hospitals: BID-Plymouth, BID-Milton and BID-Needham**

Beth Israel Deaconess Hospital Community One recognizes Integrity, Respect, Trust, Teamwork and Excellence as the Core Values of our organization. It is the philosophy of Beth Israel Deaconess Hospital Community One facilities to follow the LEAN methodology in order to provide the full continuum of health care services and the best quality patient centered care.

The Revenue Integrity Manager, working under the general direction of the Director, Revenue Cycle, provides analysis/review of chargemaster, charge capture and charge reconciliation and while exhibiting innovation good judgement as well as a thorough knowledge of ethical and legal billing procedures for hospital billing.

The Revenue Integrity Manager adheres to hospital and department policies and procedures at all times while observing confidentiality in all matters. The Revenue Integrity Manager has a clear understanding of chargemaster related impacts to the hospital, revenue cycle operations and overall financial performance.

Position Summary:

With minimal supervision, utilizes Charge Description Master (CDM) management software to maintain a complete, accurate and standardized CDM, with uniform data elements and consistency with clinical practice; provides support, education and guidance to Clinical and Administrative Departments in order to maximize appropriate revenue for the system. The Revenue Integrity Analyst will also be responsible for reviewing, analyzing, and trending information being reported in order to identify the root-cause of issues and facilitate operational changes to improve net revenue and reductions in denials.

Key Responsibilities:
Processes CDM additions, deletions and change requests while maintaining compliance with local, state and federal regulatory agencies.
Performs detailed, annual review of the CDM and CPT/HCPC code changes and updates Meditech and Craneware systems, including charge tickets/encounter forms.
Responsible for the training of hospital departments regarding compliant charge practice; the CDM maintenance process; annual CPT/HCPC code updates; and charge capture improvement.
Daily review of departmental revenue, charge rejections, and late charges to identify variances/trends in order to work with departments on timely resolution.
Monitors government and commercial payers for updates and changes to billing and/or regulatory charge master requirements. Communicates and educates clinical and administrative staff on any actions required to comply with new regulations.
Works with the compliance department to design audit processes, policies and procedures.
Identify when rebilling is needed and coordinate the rebilling process with the Clinical & Fiscal Integration Team and Patient Financial Services.
Collaborates with the clinical departments and enterprise Information System team to ensure that the appropriate ancillary/clinical modules are updated appropriately.
Serves as subject matter expert related to charging and billing issues and assists in developing and maintaining CDM related policies and procedures.
Audits charges being captured and reconciled by clinical departments for accuracy and completeness. Ensures that charges are crossing to the bill as intended.
Participates with Charge Master/IT Governance Team.
Collaboration with Reimbursement Team on insurance contracting.
Pricing Standardization across all facilities.
Travel to all facilities required. Dependable transportation.

Required Knowledge and Skills:
Experience with chargemaster maintenance or proficient knowledge of chargemaster components (CPT, HCPCs, Revenue Codes)
Experience using Craneware Charge Master Toolkit and Meditech Patient Accounting
Knowledge of CPT-HCPCS, third party reimbursement methodologies, and revenue cycle process
Thorough understanding of the CDM relationship to general ledger, cost accounting, cost reporting, budget, coding, billing and compliance in a hospital setting
Expert knowledge of inpatient and outpatient billing requirements, coding guidelines and CMS Medicare reimbursement methodology
Must be flexible and be able to adjust in changing environments, including traveling to each facility
Excellent communication and interpersonal skills with the ability to effectively interpret, communicate, and educate others
Strong quantitative, analytical and organizational skills
Ability to respond to complex inquiries in a professional and efficient manner

Education and Experience:
Education: Bachelors degree in Nursing, Accounting, Finance, Healthcare Administration or Business Administration or 3 years of direct chargemaster experience.
Experience (Type & Length): Minimum five years health care with three years chargemaster or billing or coding.
Certification/Licensure: Certified coder a plus.
Software/Hardware: Proficient in using Microsoft Excel, PowerPoint and Word.

Employment Type

  • Full time

Beth Israel Deaconess Hospital - Plymouth

275 Sandwich Street
Plymouth, MA 02360

Phone: (508) 830-2030

Fax: (508) 830-2030