Revenue Integrity Manager

Revenue Integrity Manager

Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care.

Job Summary

The Revenue Integrity Manager will lead the development of the revenue integrity function and is responsible for the oversight and management of the revenue integrity team. This position is accountable for optimizing revenue by ensuring accurate, compliant, and efficient charge capture and billing practice. The Revenue Integrity Manager will improve the performance of revenue cycle processes including developing best practices, coordinating issue resolution, establishing proactive lost revenue prevention measures, and monitoring compliance. The ideal candidate has a strong understanding of EPIC systems, coding standards, and billing regulations across both physician and facility revenue streams.

What you will do

• Utilize data analytics and process improvement techniques to identify potential revenue leakage and support accurate charge capture. Use EPIC reporting tools to extract and analyze charge data. Perform extensive data mining, develop reports, review trends, and recommend enhancements to resolve lost revenue.
• Manage a team of chart reviewers. Design and implement a chart review program to ensure completeness of records, appropriateness of billing, and compliance with regulatory and payer requirements.
• Identify coding and documentation discrepancies to provide recommendations. Monitor for positive or negative trends in coding, charge capture and / or editing processes. Analyze denial trends related to charge capture and billing. Collaborate with coding, billing, and clinical teams to identify root causes and implement corrective actions.
• Maintain documentation of audit findings, trends, and resolutions to support compliance and training efforts. Measure key performance indicators (KPIs). Prepare reports and present findings and recommendations to management.
• Oversee and maintain the CDM, identifying opportunities for missed revenue. Including an annual comparison of Prevea's CDM and supply / implant costs to payer contracts. Develop and maintain all retail pricing. Participate in service line pricing reviews.
• Research and stay current on CMS, federal and state regulations, payor guidelines, ensuring compliance and alignment with charge, coding and charge edits. Complete analysis of revenue impacts as a result of CMS payment changes.
• Performs full range of managerial responsibilities which may include but not be limited to interviewing, hiring, coaching and developing employees; planning, assigning and directing work. Encourage innovation, teamwork, fiscal responsibility, and high-quality work.

Education Qualifications

Experience Qualifications

Skills and Abilities

Licenses and Certifications

Physical Demands

Working Conditions

Travel Requirements

Hearing Requirements

Vision Requirements

Prevea is an Equal Employment Opportunity / Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov / E-Verify