Mgr, Revenue Integrity
The Manager of Revenue Integrity is responsible for overseeing the daily operations of the Revenue Integrity department. The Manager collaborates with the Revenue Integrity Director to operationalize Phoenix Children’s Revenue Integrity strategy and plan for improving revenue results across all revenue operations in all departments, financial processes, functions and interdependencies from the provision of patient care to final payments. It is the responsibility of the Revenue Integrity Manager to lead, coordinate, monitor, maintain, update, and analyze compliance of all Phoenix Children’s charge description master (CDM) files and charge capture practices, to optimize revenue generation and ensure compliance with all Federal, State, and third party payor applicable laws, regulations, requirements.
Revenue Integrity Manager Job Functions
1. Oversees Revenue Integrity Department staff and coordinates staff functions within Phoenix Children’s compliance program policies and guidelines.
2. Leads the CDM management and maintenance process (hospital and physician) to facilitate proper revenue generation and payment outcomes for the charging component of billing process, including change requests, to improve alignment between clinical services and third-party payor requirements.
3. Standardizes charge capture, charge flow, and charge reconciliation processes for all clinical departments.
4. Monitors healthcare trends and maintains knowledge of charge and coding related regulations and standards.
5. Leads routine charge capture assurance as well as feedback process.
6. Provides focused education to clinical and coding stakeholders.
7. Monitors and trends Key Performance Indicators (KPIs) to identify new Revenue Integrity initiatives, track performance improvement activities, and document improved performance for the Director.
8. Provides evaluation, reports, and advice as well as improvement recommendations to management in all service lines.
9. Collaborates closely with the Revenue Integrity Director, Compliance, Central Business Office, Transplant Revenue Cycle, Health Information Management (HIM), Information Technology (IT), Managed Care, and Finance to facilitate proper coding and billing outcomes.
10. Supports Revenue Integrity Committee and Phoenix Children’s strategic Revenue Cycle plan by enhancing aspects of the revenue cycle process to ensure services rendered are accurately and appropriately charged and paid correctly while maintaining compliance with all Federal and State regulations, and coding guidelines.
11. Serves as a clinical departmental liaison regarding reimbursement and charge capture compliance issues, Federal and State healthcare regulatory requirements relevant to coding and charges, applies knowledge to ensure that charges are accurate, billed correctly, and supportable according to payer and regulatory requirements, and communicates necessary CDM changes to departments impacted by changes.
12. Leads root cause analysis investigations resulting from charge capture, reconciliation, and/or the CDM to resolve frequently occurring payor denials, coding edits, or other delays or reductions to cash flow and best practice charge capture.
13. Implements strategic pricing strategy to optimize reimbursement within Phoenix Children’s budget requirements.
14. Supports the initiatives of the Denials Governance Committee, focusing on denials prevention activities and performance improvement.
15. Implements annual/quarterly CMS and AMA code changes, payment, and status indicator changes pertinent to charge capture, cash flow, and revenue optimization. Communicates changes to impacted clinical areas and ensures changes to the CDM and any/all ancillary systems as necessary to remain in compliance.
16. Maintains an inventory of charge capture process and tools in each department for the Director.
17. Supports vendor vetting and selection when determining the party to perform CDM reviews, charge capture audits, and provide revenue integrity software and/or consulting support.
18. Reports and trends charge capture related metrics evidencing CDM compliance improvements and incremental revenue generated as a result of the work of Revenue Integrity staff.
19. Leads CDM and service inventory reviews ensuring all services, supplies, implantable devices, and ancillaries are charged for and generating appropriate revenue for all chargeable patient services provided according to the charge capture strategies and policies of Phoenix Children’s and in compliance with all regulatory and payor guidelines.
20. Reports, trends, and distributes reports tracking charge lag and daily charge reconciliation for all clinical departments.
21. Assists clinical departments in implementing process improvement to reduce and eliminate charge capture issues.
22. Supports the Revenue Integrity Director’s collaboration with Information Technology to ensure
• All system implementations, including departmental moves, are reviewed in advance to prepare and limit impact to ordering and charging systems, as well as process.
• All system upgrades are reviewed in advance to prepare for impact to ordering and charging systems, as well as charge capture processes.
23. Conducts post-implementation auditing to ensure that CDM changes result in appropriate reimbursement.
- Directly supervises assigned Revenue Integrity staff.
- Ensures employee performance evaluations are conducted in a timely manner, are fair and consistent, and that performance expectations are communicated.
- Performs conflict resolution, problem solving, and initiates progressive disciplinary action with consultation by the Director when necessary.
- Completes assigned Revenue Integrity staff performance evaluations and annual educational requirements.
- Responsible for the appropriate orientation, development, and training of Revenue Integrity staff.
- Communicates departmental goals and objectives that support and enhance Phoenix Children’s mission. Measures and tracks the goals and objectives of the Revenue Integrity Department.
- Provides leadership in identifying inter/intra departmental issues and problem resolution.
- Promotes and establishes an atmosphere of performance improvement throughout the department utilizing motivation, coaching, and staff development.
- Implements departmental policies and procedures.
- Directs staff in compliance with established policies and procedures, regulations or applicable regulatory agencies and Joint Commission standards.
- Performs miscellaneous job related duties as requested.
Phoenix Children's Mission, Vision, & Values
To advance hope, healing and the best healthcare for children and their familiesVision
Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.
We realize this vision by:
- Offering the most comprehensive care across ages, communities and specialties
- Investing in innovative research, including emerging treatments, tools and technologies
- Advancing education and training to shape the next generation of clinical leaders
- Advocating for the health and well-being of children and families
- We place children and families at the center of all we do
- We deliver exceptional care, every day and in every way
- We collaborate with colleagues, partners and communities to amplify our impact
- We set the standards of pediatric healthcare today, and innovate for the future
- We are accountable for making the highest quality care accessible and affordable