Manager, Revenue Integrity Charge Capture

Primary Purpose

Responsible for managing the daily functions of the Revenue Integrity-Charge Capture team and Charge Capture Coding Team.

Responsible for the Charge Capture and Reconciliation process related to charge entry process. Will monitor and promote processes that will reduce late charges and support timely billing. The Manager of Revenue Integrity-Charge Capture plays a leadership role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation. Required to understand and communicate complex issues and changes relating to regulatory compliance and third-party reimbursement to the department(s) involved, maintain records of their notification, accountability and compliance. Will provide essential quality reports and advice and improvement recommendations to leadership along all revenue generating service lines for the hospital system.

Minimum Specifications

Education

• High School Diploma
• Bachelor's degree in Accounting, Business, or Healthcare related field, preferred.

Experience

• Four years of experience in managing or leading Charge Capture and/or Charge Generation initiatives.

Equivalent Education and/or Experience

• May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.

Required Tests for Placement

• Must be able to successfully pass the Intermediate-level Microsoft Excel test, as established by Workforce Planning & Recruitment, with a minimum score of 70%.

Skills or Special Abilities

• Must be able to effectively supervise, educate, and train employees.
• Must have effective project management skills.
• Must have strong computer skills using MS Excel and Word and the ability to learn various software.
• Must have critical thinking and problem-solving skills.
• Excellent oral and written communications skills are required with the ability to deal with information of confidential nature.
• Strong customer service and communication skills are essential for responding to requests and explaining analysis.
• Must be able to interact tactfully and effectively with physicians, clinicians, nurses, and others inside and outside of PHHS's organization regarding charging rules and regulations.
• Must have actively participated in Payor Joint Operating Committee meetings with Managed Care Payors.
• Must be familiar with review and interpretation of terms and conditions commonly within Managed Care contracts.
• Expertise with CPT, HCPCS, and Revenue coding with an ability to process changes.
• Must have a thorough understanding of medical terminology.

Responsibilities

• Will monitor, assist and coordinate the activity of the charge capture to ensure accurate and timely submission of charges.
• Will perform and provide quality Review Audits of the Charge Capture Team and the CDM Team to provide ongoing educational training and process improvement. Will provide guidance coaching mentoring and feedback to ensure successful operations.
• Will work with Revenue Generating Departments on Revenue Reconciliation to ensure accurate submission of charges for all services provided. Will work with Revenue Generating Departments on reducing the amount of Late Charges generated by assisting with identifying root causes and resolution to ensure timely billing.
• Will provide ongoing education in the use of the Revenue Reconciliation tool available for daily review and verification of charges generated.
• Will manage all work queues assigned to Revenue Integrity and provide timely direction to ensure these work queues are working daily to quickly identify and resolve charging issues and prevent billing delays.
• Maintains positive working relationships with other hospital departments such as Patient Financial Services, Medical Records, Compliance, and the Medical Staff Office to ensure that the charging and billing responsibilities of the department are performed in an expeditious and thorough manner.
• Stays abreast of the latest developments, advancements and trends related to regulatory updates by attending seminars or workshops and reading professional journals, integrating this knowledge into current work practices. Develops effective internal controls that promote adherence to applicable regulatory agencies and private health programs. Seeks advance and guidance as necessary to ensure proper understanding. Will coordinate and track on-going departmental continuing educational hours as it relates to these Regulatory changes and/or billing changes.
• Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the functional area. Identifies and analyzes and works with the Manager of Revenue Integrity-CDM regarding the design of jobs, work processes, work flows, etc. for the department as it relates to charging and billing for its services and implements appropriate changes to improve effectiveness, productivity and efficiency.
• Responsible for promoting adherence to applicable rules and regulations of various governmental regulatory groups and programs. Researches applicable charging and billing rules and regulations and provide supporting reimbursement guidance and documentation required to ensure proper charging protocols are met.
• Identify opportunities and make recommendations for interdisciplinary and department process improvement such as analyzing Return to Providers (RTPs) or work queues. Lead department teams to implement changes, creating work plan and department procedures as required.
• Will function as the liaison between departments, Information Technology, and Revenue Integrity with the goal of creating an efficient charge generation processes that promotes timely charge capture and billing required to expedite the reimbursement process. Will identify charge generation process between EPIC and the end user.
• Will assist with managing EPIC Billing projects, such as, CDM Reconciliation project, Charge Capture project, Physician Billing Project, and others to ensure PHHS's remain as close to EPIC's best Practice with the aim of improving our charge generation and billing process.
• Coordinates or assists in special projects within the Revenue Integrity Department, such as determining the effects of proposed or implemented changes in reimbursement rules or providing support during pricing or charge master maintenance.
• Will review and update all Revenue Integrity's Policy and Procedures as required to ensure Departmental compliance with policy update as required. Will manage time in PeopleSoft for all Revenue Integrity employees.
• Coordinates or assists in special projects within the Revenue Integrity department as assigned by management.

Job Accountabilities

• Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the department and Parkland.
• Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
• Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
• Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
• Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of Parkland.
• Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.