When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Job Type:

Regular

Scheduled Hours:

40

Work Shift:

Day (United States of America)

Under the direction of the Director of Revenue Integrity, the Manager Revenue Integrity will be responsible for managing revenue integrity operations for the hospital. Provides oversight and leadership for a team responsible for, but not limited to, charge description master (CDM) maintenance, centralized charge control, pre-bill edits, appropriate revenue and reimbursement, and denial prevention. Manages and monitors the results, data analysis and root cause issues and assists departments with corrective action plans. Responsible for building collaborative relationships with BIDMC leadership, HMFP, and other key stakeholders. Motivates and challenges staff to achieve the highest levels of performance, working in conjunction with all key stakeholders to prevent revenue deficits and maximize potential revenue for the region. Responsible for managing the optimization of staff performance through process redesign, policy/procedure implementation, communications, continuing education and professional development activities, staff empowerment and outcome feedback.

Job Description:

Essential Responsibilities:

• Manages and oversees people, systems and processes for revenue integrity, charge control functions, CDM, and the performance of standard revenue integrity metrics and quality.

• Facilitates and serves as a champion for process change. Works closely with clinical leadership on implementing revenue enhancement initiatives and education.

• Performs assessments, analytical research and support including, but not limited to: root-cause, analyses, cost/benefit analyses, and financial projection for small departments based on volume and/or revenue.

• Support clinical areas with ad hoc inquiries related to compliant charge capture practices as needed.

• Keeps abreast of all regulatory policies impacting charge capture, operationalizing changes as needed.

• Develops work plans and leads project timelines for small initiatives to complete assigned projects.

• Oversees denials root cause analyses related to revenue integrity workflows (charge capture, CDM, etc.) and reports findings and recommendations to denials committees.

• Ensures charge capture projects are implemented with proper oversight and performs subsequent reviews/audits after implementation to ensure project goals are achieved.

• Performs other tasks and work as assigned.

• Has the authority to direct and support employees daily work activities. Has authority to undertake or recommend the following employment actions: hiring, termination, corrective action and performance reviews. Direct Reports: 2-3 Indirect Reports: None

• Assists in planning, monitoring and/or managing budget in functional area of department.

Required Qualifications:

• Bachelor's degree required.

• 5-8 years related work experience required and 3-5 years supervisory/management experience required

• Extensive understanding of correct coding principles of CPT/HCSPCS and modifier selection as well as CCI edits and billing guidelines.

• Intermediate analytical skills to evaluate information gathered from multiple sources and synthesize into actionable information

• Interviewing/listening skills required to enable talking with individuals and groups about current processes and issues to ask the right questions to yield essential information that will be used to evaluate processes and determine potential solutions.

• Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.

Preferred Qualifications:

• RHIA, RHIT, CCS, CPC/COC, CPC-H, or other coding credentials preferred, but not required.

Competencies:

• Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.

• Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.

• Independence of Action: Ability to set goals and priorities for functional area. May make recommendations for department policies, practices and programs. Manager or Director provides broad guidance and overall direction.

• Written Communications: Ability to communicate complex information in English effectively in writing to all levels of staff, management and external customers across functional areas.

• Oral Communications: Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate, motivate and persuade others.

• Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.

• Team Work: Ability to lead collaborative teams for larger projects or groups both internal and external to the Medical Center and across functional areas. Results have implications for the management and operations of multiple areas of the organization.

• Customer Service: Ability to lead operational initiatives to meet or exceed customer service standards and expectations in assigned unit(s) and/or across multiple areas in a timely and respectful manner.

Physical Nature of the Job:

Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally.

FLSA Status:

Exempt

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled