AddressRevenue Integrity Manager
Primary responsibility of a Revenue Integrity Manager is to ensure accurate billing, compliance, and revenue optimization. Here are the key aspects of a Revenue Integrity Manager's job description:
Responsibilities:
- Ensuring accurate billing and compliance with regulations/payor contracts/hospital tariffs
- Reviewing systems and processes to identify compliance issues.
- Collaborating with different departments, physicians and insurance companies to provide price estimations for various medical procedures.
- Providing guidance on appropriate billing practices and medical procedure coding guidelines.
- Conducting training related to billing processes and compliance.
- Analyzing existing revenue cycle processes and recommending improvements.
- Setting up procedures compliantly for hospital and physician charges.
- Preventing revenue leakage through effective processes, controls and audits.
- Review assignment of codes to medical procedures and diagnoses.
- Ensuring correct code sequencing per regulations, coding guidelines and policies.
- Verifying and clarifying information from physicians, patients and auditors.
- Collecting data for and presenting monthly reporting to Finance Head.
- Support with system enhancements to optimize revenue cycle management.
Qualifications/Skill Sets/Experience:
- Certified Professional Coder (CPC) certification required, with excellent coding proficiency in CPT- , HCPCS Level II & ICD-10-CM
- Understanding of EDI file formats (?)
- Bachelor's/Master's degree in healthcare administration, finance, or related field.
- Experience in healthcare finance, compliance, or revenue management.
- Knowledge of coding guidelines and documentation requirements.
- Experience in US Healthcare Revenue Cycle Management processes would be an added advantage
- Strong Communication skills
- Minimum 5 years of experience after CPC certification
