Revenue Integrity Program Manager

This position involves managing the Revenue Integrity Program with responsibilities including ensuring adequate training on accurate charge capture and documentation requirements, overseeing charge reconciliation and charge capture processes, developing and maintaining charging policy and training, collaborating with key revenue producing departments, researching billing and coding requirements for new procedures, and monitoring billing and coding compliance and reimbursement.

Key duties:

• Train providers and foundations staff on accurate charge capture and documentation.
• Oversee charge reconciliation and charge capture processes and materials.
• Collaborate with foundations and revenue departments to identify billable services and establish charge processes.
• Research billing and coding for new procedures/supplies; ensure systems are correctly set up and claims reimbursed correctly.
• Liaise with Foundations, Finance, Compliance, HIM, Coding, CDI, Clinical Departments, IT, and others.
• Disseminate payer regulations and requirements to stakeholders.
• Communicate coding and billing updates to stakeholders.
• Work with Professional Coding, Foundations, and Compliance teams to review charges, investigate trends, provide education, and ensure compliance.
• Maintain database of revenue optimization opportunities and present findings to committees.
• Assist with third-party payer contract language related to coding standards.
• Develop and monitor performance metrics for Revenue Integrity team.

Qualifications:

• Bachelor's degree or equivalent experience.
• 8-10+ years healthcare revenue cycle experience focusing on professional billing.
• Direct management experience.
• Preferred clinical license (RN, RT, MT, RPh).
• Preferred coding certifications: CPC, COC, AHIMA CCS.
• Preferred PMP certification.

Standard full-time, 40 hours per week. Hybrid work model is available.

Salary range: $99,153.60 - $158,631.20 annually.

Work location: Westwood, MA.