Revenue Integrity Program Manager

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This is a Stanford Health Care job.

A Brief Overview
The Revenue Integrity Program Manager is a critical role responsible for optimizing hospital and professional revenue, identifying potential revenue leakage while ensuring compliance in charging and billing practices within the healthcare system. Serving as the primary liaison for Revenue Cycle, This position interfaces directly with clinical departments leaders, Clinical Department Chairs, and School of Medicine Directors of Finance & Administration (DFA).
Through a combination of data analytics, and process improvement techniques, this role will support the accurate capture of charges, identify meaningful opportunities to improve, and work closely with physician leadership and partnering with Compliance to provide education and training. This position will also provide ongoing communication through reports & regular presentations as well as handling intake of requests and potential improvement opportunities. Prepares and leads the monthly Revenue Integrity and the School of Medicine DFA meetings for professional revenue cycle.

Locations

Stanford Health Care

What you will do

• Charging Optimization: Conducts prospective and retrospective reviews/audits of charge capture practices in the clinical departments. Reports findings, provides education to both Providers and charge capture support staff. Coordinates charge capture improvement tools in collaboration with Revenue Cycle TDS IT teams. Reports potential compliance issues for further analysis and follow-up to the Compliance Department.

• CDM Optimization: Works to ensure a compliant and consistent system CDM. Works with existing tools to evaluate CDM requests with a focus on regulatory coding, compliance, and adherence to SHC internal guidelines regarding CDM maintenance, standard naming conventions and pricing integrity.

• Department Education: In collaboration with the Compliance Department, provides education to clinical department staff regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliance use.

• Project Management: Leads projects to improve revenue capture, increase efficiencies in the charge capture process, and reduce provider burden with the charging process.

• Financial Analysis: Performs basic financial analyses to report the impact of charge capture practice changes and corrections to current practices. Communicates findings fully with clinical departments and executive team.

• Issue Resolution: Through the combination of EPIC WQs, external edit platforms, and ongoing evaluation, identifies charging issues and works to identify solutions.

• Performance Review: Provides ongoing reporting of revenue performance to a variety of audiences including Chairs, Faculty, DFA’s, Division and Clinic Chiefs, Executive Director, Mid-Revenue Cycle, the Director of Revenue Integrity and others as appropriate. Responsible to present confidently to a wide range of individuals across the organization.

Education Qualifications

• Bachelor's degree in a work-related discipline/field from an accredited college or university (or equivalent combination of education/experience)

Experience Qualifications

• Five (5) years of progressively responsible directly related work experience

Required Knowledge, Skills and Abilities

• Proficient in hospital and professional revenue cycle operations.

• Expert in analyzing revenue data to identify trends and opportunities with the capacity to communicate findings effectively to varied audiences. Ability to analyze revenue data and identify trends and opportunities and the ability to present such data to a variety of audiences

• Strong Interpersonal skills facilitating seamless communication with clinical staff, and faculty. hat allow ease of communication with Clinical staff and faculty

• Solid understanding of coding conventions and current third-party payer rules and regulations Knowledge of coding conventions

• Current knowledge of third party payer rules and regulations

• Knowledge of computer systems, specifically, Epic Care and related interfaces

• Knowledge of management and supervision and the ability to organize staff’s work

• Strong written and verbal communication skills to articulate analyses and finding to Chairs, DFAs and Clinical Operations leadership. Ability to write, and speak to the analyses performed

• Proven Ability to provide leadership skills in problem identification and issue resolution

• Ability to influence decision-making through persuasive data-supported arguments. Ability to change the course of events through convincing arguments supported by data

• Ability to apply critical thinking skills to complex issues and situations

• Competence in mediating and solving intricate work problems. Ability to mediate and solve complex work problems and issues

• Ability to effectively facilitate work groups towards to successful outcomes

• Ability to facilitate stakeholder meetings, including agenda development, discussion, documentation, action item follow-up and presentation development.

• Strong organizational skills and attention to detail, with the ability to manage multiple priorities effectively.

Licenses and Certifications

• Non ClinicalCOC - Certified Outpatient Coder preferred . or

• CPC-H preferred . or

• CCS - Certified Coding Specialist preferred . or

• CPC and/or CCSP - Certified Professional Coder preferred . or

• RHIT - Registered Health Information Technician preferred . or

• RHIA - Registered Health Information Administrator preferred .

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination inall ofits policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.