Penn Highlands Healthcare

  • Revenue Integrity Manager

    Job Location US-PA-DuBois
    Posted Date 5 months ago(1/5/2018 2:28 PM)
    Job ID
    2018-10935
    # of Openings
    1
    Hours/Pay
    80
    Department
    Revenue Management
    Shift
    1st Shift (Day)
    Type
    Full Time
  • Overview

    The best of modern health care technology, plus the best of small town America!

    Located in the midst of the beautiful rolling hills and woodlands of Pennsylvania, you don't have to be a native to feel at home here. No matter where your roots, you'll quickly recognize that the staff at Penn Highlands DuBois (PHD), like other residents of the community, will make you feel right at home.

     

    Penn Highlands DuBois (PHD) offers residents of west central Pennsylvania a rare combination of technologically advanced health care in a warm, friendly environment. Widely recognized as one of the leading health centers of its kind in the commonwealth, PHD is an oasis of clinical and technical excellence, with a focus on patient-centered care. Its rural setting is just far enough from the hustle of the city life to make it peaceful, but close enough to provide easy access to sought-after urban attractions.


     

    THE FOCUS OF THIS POSITION IS TO PLAN, DIRECT, COORDINATE, AND IMPLEMENT A FULLY INTEGRATED REVENUE INTEGRITY; CHARGE DESCRIPTION MASTER INTEGRITY AND CHARGE CAPTURE ENVIRONMENT THAT WILL ENABLE ALL DEPARTMENTS AND ORGANIZATIONAL ENTITIES TO MONITOR AND CAPITALIZE ON ALL POTENTIAL REVENUE OPPORTUNITIES.

    THIS POSITION WILL ALSO EXPLORE MEANS OF MAXIMIZING COLLECTIONS THROUGH THE ACCURATE AND COMPLETE CAPTURE OF ALL CHARGES, OVERSEE THE ESTABLISHMENT OF AN APPROPRIATE CHARGE STRUCTURE AND CHARGE RATES CONSISTENT WITH INDUSTRY STANDARDS AND PAYER CONTRACTS, CLOSELY OBSERVE DENIAL TRENDS, DIRECT THE IMPLEMENTATION AND MAINTENANCE OF CHARGE STRUCTURE AND CHARGE MASTER, AND OVERSEE THE EDUCATION OF REVENUE DEPARTMENT MANAGERS AND DIRECTORS REGARDING THE RELEVANCE OF THEIR ROLES AND RESPONSIBILITIES TO EFFECTIVE REVENUE CAPTURE.

    THIS POSITION SUPPORTS THE HOSPITAL’S CORPORATE COMPLIANCE PROGRAM BY VERIFYING ADHERENCE TO CHARGE POSTING POLICIES AND PROCEDURES AND ENSURING THAT THE CHARGE MASTER COMPLIES WITH ALL APPLICABLE REGULATORY AND INDUSTRY CODING GUIDELINES.

     

    Responsibilities

    *Complies with PENN HIGHLANDS DUBOIS policies and procedures, accreditation agency requirements, and federal, state or local law and regulations


    Works closely with members of the finance department and patient financial services team to determine appropriate reimbursement levels for services and provides feedback and analysis to departments to optimize reimbursement levels; develops payer scorecards to leverage during contract negotiations

     
    Stays current on regulatory issues that affect billing, coding, and compliance and educates directors and managers regarding potential changes in coding and billing regulations

     
    Maintains responsibility for developing and enhancing the charge master, including reviewing charge structures, incorporating updated rules, and ensuring clean line items

     
    Oversees CDM maintenance by analyzing departmental charges, identifying and implementing charge improvements, assisting individual departments with reconciling charge discrepancies, and determining the reimbursement impact of CPT revisions

     
    Coordinates and oversees the hospital audit process, including entering audit data into various tracking tools, coordinating deadlines with individual departments and external business partners, and analyzing audit findings as they relate to hospital operations

     
    Coordinates the hospital charge audit process by entering charge capture data into tracking tools, and analyzes audit findings for improvement opportunities

     
    Arranges audit timelines with individual departments and external business partners, and ensures each party meets set deadlines

     
    Conducts routine quality control audits of random sample cases; reports practices requiring corrective action to departmental leadership

    Reviews billing workflows and works with the appropriate teams to adjust billing systems to better catch errors and/or omissions

     
    Oversees managed care reimbursement accuracy, including identifying appropriate tools to monitor the reimbursement practices of third-party payers and ensuring contract language results in accurate reimbursements

     
    Monitors and trends denials, identifying root causes of payment discrepancies; provides feedback to each department on how to reduce denials

     
    Assists in overseeing PHH’s charge capture system to promote its accuracy and Integrity across revenue-generating departments and entities.


    Prepares departmental summaries that pinpoint root causes of charge/billing errors and conceptualize process changes for service line leaders; uses hospital denials data to support findings


    Collaborates with key constituents in different functional areas to create charge and billing reports that meet the organization’s requirements and trains individual departments on how to properly generate such reports


    Participates in charge master (CDM) maintenance efforts by reviewing whether charges accurately reflect provided services/supplies and are consistent with industry best practices


    Reviews changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable charging and billing guidelines


    Recommends new categories for CDM inclusion based on audit findings and solicited staff suggestions


    Fine-tunes and maintains current charge capture methodologies and tools with the finance department


    Summarizes hospital- or health system-wide charge audit findings to executive staff, board members, and/or the compliance committee in efforts to ensure all charges are properly captured and reimbursed


    Collaborates with revenue integrity leadership to develop education plans to assist clinical service line leaders in achieving optimal reimbursement; may coordinate revenue integrity staff training


    Networks with revenue integrity leaders from other organizations to ensure organizational performance is reflective of general industry trends


    Maintains knowledge of and adherence to code of conduct standards, confidentiality agreements, and PHH’s mission statement


    Other duties as assigned.

    Qualifications

    • BACHELOR’S DEGREE IN BUSINESS, FINANCE, ACCOUNTING, NURSING OR RELATED FIELD REQUIRED.
    • ADVANCED DEGREE OR MBA, PREFERRED.
    • CERTIFICATION OR LICENSE BY ANY OF THE FOLLOWING: RHIA, RHIT, CPC, CPC-H, CCS, or CCS-P, RN (LICENSE IN THE STATE OF PA)
    • AT LEAST 5 YEARS OF CLINICAL HEALTH EXPERIENCE REQUIRED
    • WORKING KNOWLEDGE OF FINANCIAL STATEMENTS, AS WELL AS THE ABILITY TO ANALYZE FINANCIAL INFORMATION AND DETERMINE THE IMPACT OF POSSIBLE CHANGES.
    • ABILITY TO TAKE INITIATIVE TO IDENTIFY PROBLEMS, CONCEPTUALIZE RESOLUTIONS, AND IMPLEMENT CHANGE.
    • EXPERIENCE WITH OVERSEEING AND DIRECTING SUBORDINATES.
    • STRONG COMFORT LEVEL WITH COMPUTER SYSTEMS

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