Manager Professional Revenue Integrity (Hybrid) (Houston)

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

This position is responsible for overseeing and managing all aspects of professional charge functions to ensure the integrity of the organizations revenue. This role effectively summarizes findings to support the development of processes and procedures, demonstrating awareness of financial implications of decisions and business impact. This position maintains a thorough comprehension of revenue cycle processes including Charge Capture, Charge Reconciliation, Data Analytics, Pricing and Professional Billing. Collaboration with Revenue Cycle, Clinical Departments, and Finance is essential to ensure accurate revenue capture, compliance, and optimization. This position supports the ongoing integrity of charge activity inclusive of technical and operational workflow and functionalities. Typically reports to the Director, Revenue Integrity.

Job Description

Desired Skill Sets :

Previous Revenue Integrity experience preferred

Experience working for a large healthcare system highly preferred

Must have Epic experience - prefer a super-user

Well-rounded and extensive background in Revenue Cycle

Heavy project management experience

Extensive data analysis capabilities

Knowledge of medical coding would be helpful

Open to candidates with front end business office experience and back end Revenue Cycle experience

MINIMUM QUALIFICATIONS

Education : High School Diploma required. Bachelors degree in Healthcare Administration, Business Administration, Accounting or related field preferred.

Licenses / Certifications : Certification(s) preferred :

Certified Professional Coder (CPC)

Certified Medical Coder (CMC)

Epic certification such as ARCR : Resolute Professional Billing Claims and Billing Readiness

Project Management Professional (PMP)

Experience / Knowledge / Skills :

Five (5) years of Physician / Professional Billing experience required.

Three (3) years in a management or supervisory level position for a large health system preferred.

Extensive knowledge and experience with Epic EMR system, specifically with EPIC Resolute Billing with a large health system.

Experience in Charge Capture, Charge Reconciliation, and Charge Pricing.

Comprehensive understanding of healthcare billing and coding systems (e.g., HCPCS, ICD-10).

Supervisory and mentoring skills necessary to provide support to department and promote employee development.

Advanced proficiency in Microsoft Excel and other Microsoft Business applications (i.e. Word, PowerPoint).

Strong communication skills and ability to successfully collaborate with team members across the organization at all levels.

Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.

Ability to supervise and train employees, including organizing, prioritizing, and scheduling work assignments to meet timelines.

Ability to collaborate and address problems in an organized manner involving multiple variables within the scope of the position.

Ability to make independent decisions when circumstances warrant; make prompt and accurate judgments regarding other job duties.

PRINCIPAL ACCOUNTABILITIES

Manages all facets of professional revenue integrity processes to achieve and exceed best practice benchmarks.

Serves as liaison between revenue cycle and clinical departments.

Contributes to the organization's financial performance by implementing process enhancements, optimizing charge capture and reconciliation, and maximizing revenue to achieve optimal reimbursement for services rendered.

Ensures a process is in place to reconcile charges back to the daily ancillary and clinic patient schedules.

Monitors daily reconciliation reports to assist departments in maintaining accurate and timely charges.

Maintains current working knowledge of billing systems, claim submission, remittance advices, explanation of benefits, reimbursement methodology, payer systems, payer requirements, general coding, APC, CPT and HCPCs.

Closely monitors volumes and performance of charge review work queues, charge edits, and reports while actively seeking opportunity, deficiencies, and improvement strategies to minimize lag hold.

Supports best practices for professional services coding and clinical documentation.

Supports Managed Care in reimbursement fee schedule maintenance.

Reviews analyses, reports, KPIs, and operational metrics. Participates in corrective actions in response to variances and trends.

Utilizes a data-driven approach to prioritize actionable improvements resulting from root cause denial analysis, promoting prevention and error reduction involving assessment of system edits, provider education, and clinic management feedback.

Ensures that the activities of the professional revenue integrity team are conducted in a manner that is consistent with overall department protocol, Policies and Procedures, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.

Supports strategic plans to ensure the revenue integrity department is progressive and effective; works with other departments and practices to promote consistency in processes; stays up-to-date on all regulatory billing requirements; effectively coordinates work flow to ensure optimal quality of data and timely reimbursement.

Effectively communicates with all levels of managers and staff, and actively participates in performance management initiatives.

Maintains a positive cooperative relationship with all groups across billing and non-billing areas. Sets a positive example in collaborating initiatives, identifying solutions, measuring, and sharing results and providing specific feedback.

Oversees management of appropriate personnel, providing recommendations for hiring, promotion, salary adjustment and personnel action.

Manages staffing levels and productivity. Provides team communication regarding department updates, organizational activities, financial performance, educational opportunities, interdepartmental activities, and QI activities.

Manages productivity and quality of output from the team through data, usage, and reports.

Ensures the recruitment, training, and retention of motivated, competent revenue integrity analysts; establishes goals and standards for performance appraisals.

Provides, oversees, and / or coordinates the provision of training for new and existing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques

Guides individuals and groups toward desired outcomes, setting performance standards and delivering leading quality services.

Complies with HIPAA and all relevant laws, rules regulations and accreditation standards and requirements.

Adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity, and quality of service.

Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

Promotes individual professional growth and development by meeting requirements for mandatory / continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermanns service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.

Other duties as assigned.