Revenue Integrity Corporate Manager

Partners Healthcare System Somerville , MA 02143

Posted 3 weeks ago

As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Partners HealthCare supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential.

Partners HealthCare is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal developmentand we recognize success at every step.

Our employees use the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done:

Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

Overview

Reporting to the Director of Revenue Integrity, the Corporate Manager of Revenue Integrity plays an important 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. Working closely with the Director of Revenue Integrity, the Corporate Manager will serve as the technical clinical/coding lead in PHS contract operations issues and other revenue capture initiatives. The Corporate Manager of Revenue Integrity also manages the Charge Audit team coordinating and appealing third party charge audits.

PRINCIPAL DUTIES AND RESPONSIBILITIES

Oversee the management of Revenue Integrity Pricing, Claim edit and Revenue Integrity Analysts for OR, ED and AMB.

Take a lead role in recruiting, mentoring and coaching analysts at various levels of development.

Maintain revenue and charge capture oversight, working closely with Revenue Integrity Managers and hospital Revenue Operations team. Act as clinical/coding expert for Revenue Integrity staff.

Communicate and coordinate resolution of identified issues with denials, billing error, payment variance and contract operations stakeholders. Present regular updates on issues and efforts to senior management.

Direct and participate in complex projects related to revenue cycle initiatives.

Execute post chargemaster implementation audits to ensure that chargemaster changes result in appropriate reimbursement. This includes verifying reimbursement and coordinating the review of medical records if needed to ensure that clinical departments are processing charges appropriately.

Develop and update contract language/review logic related to clinical coding standards and requirements. Participate in internal and external contract payer discussions and negotiations regarding coding standards and billing for new technology.

Play a lead role in developing charge capture policies and procedures for PHS facilities.

Collaborate with Physician Leaders and entity committees to review new technologies and establish related charge capture and coding protocols. Ten to twelve years experience in a hospital setting or within the healthcare industry required.
5-10 years of demonstrated successful management experience required.

Clinical/or business/finance degree required.

Hospital pricing, price transparency and claim edit experience needed. Background in contract operations or billing compliance desired.

Strong computer and system experience related to multiple databases and computer logic, Epic System knowledge preferred.

SKILLS/ABILITIES/COMPETENCIES REQUIRED

Strong analytical background with ability to translate, communicate and present, at an executive level, technical clinical and coding information and findings.

Well developed, formal presentation skills

Ability to present to and interact with senior levels of hospital management and with physician leaders.

Extensive knowledge of charge creation, regulation, charge capture and reconciliation in a health care environment.

Excellent organizational and project management skills.

Strong time management, attention to detail, and follow through.

Strong management and team building skills required.



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VIEW JOBS 12/5/2019 12:00:00 AM 2020-03-04T00:00 As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Partners HealthCare supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research. We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Partners HealthCare is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step. Our employees use the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration. Overview Reporting to the Director of Revenue Integrity, the Corporate Manager of Revenue Integrity plays an important 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. Working closely with the Director of Revenue Integrity, the Corporate Manager will serve as the technical clinical/coding lead in PHS contract operations issues and other revenue capture initiatives. The Corporate Manager of Revenue Integrity also manages the Charge Audit team coordinating and appealing third party charge audits. PRINCIPAL DUTIES AND RESPONSIBILITIES Oversee the management of Revenue Integrity Pricing, Claim edit and Revenue Integrity Analysts for OR, ED and AMB. Take a lead role in recruiting, mentoring and coaching analysts at various levels of development. Maintain revenue and charge capture oversight, working closely with Revenue Integrity Managers and hospital Revenue Operations team. Act as clinical/coding expert for Revenue Integrity staff. Communicate and coordinate resolution of identified issues with denials, billing error, payment variance and contract operations stakeholders. Present regular updates on issues and efforts to senior management. Direct and participate in complex projects related to revenue cycle initiatives. Execute post chargemaster implementation audits to ensure that chargemaster changes result in appropriate reimbursement. This includes verifying reimbursement and coordinating the review of medical records if needed to ensure that clinical departments are processing charges appropriately. Develop and update contract language/review logic related to clinical coding standards and requirements. Participate in internal and external contract payer discussions and negotiations regarding coding standards and billing for new technology. Play a lead role in developing charge capture policies and procedures for PHS facilities. Collaborate with Physician Leaders and entity committees to review new technologies and establish related charge capture and coding protocols. Ten to twelve years experience in a hospital setting or within the healthcare industry required. 5-10 years of demonstrated successful management experience required. Clinical/or business/finance degree required. Hospital pricing, price transparency and claim edit experience needed. Background in contract operations or billing compliance desired. Strong computer and system experience related to multiple databases and computer logic, Epic System knowledge preferred. SKILLS/ABILITIES/COMPETENCIES REQUIRED Strong analytical background with ability to translate, communicate and present, at an executive level, technical clinical and coding information and findings. Well developed, formal presentation skills Ability to present to and interact with senior levels of hospital management and with physician leaders. Extensive knowledge of charge creation, regulation, charge capture and reconciliation in a health care environment. Excellent organizational and project management skills. Strong time management, attention to detail, and follow through. Strong management and team building skills required. Brigham And Women's Hospital Somerville MA

Revenue Integrity Corporate Manager

Partners Healthcare System