Revenue Integrity Supervisor (Hybrid)

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

This position is responsible for engaging initiatives and daily activities to ensure the integrity of the organization’s revenue. This role will fulfill duties within various functions of Revenue Integrity and can include Pricing, Charge Capture, Data Analytics, Professional Billing, and Project Management. The Senior Revenue Integrity Analyst will initiate trend assessments, monitor charge capture accuracy, analyze variances, and summarize findings with impact to revenue. This individual will engage clinical departments and providers to ensure accurate and timely charging, while serving as a liaison between Clinical Operations, Finance, and Revenue Cycle. The Senior Revenue Integrity Analyst will remain current with healthcare regulations and the impact on charging and coding, as well as maintaining professional knowledge and education. The position supports a culture of compliance, adherence to billing guidelines, ethics, integrity, and performance across the Physician Enterprise. Typically reports to the Manager, Revenue Integrity.Job Description

Desired Skill Sets:

• Seeking a certified coder
• Must have extensive Epic knowledge and experience
• Project management experience
• Extensive Revenue Cycle experience
• Prefer team lead and/or supervisor experience
• Revenue Integrity experience a plus

MINIMUM QUALIFICATIONS

Education:  Bachelor’s degree in Healthcare Administration or Business Administration preferred.

Licenses/Certifications: Revenue Cycle certification in one of the below certification(s) required:

• Accredited Coding Certification (i.e. Certified Professional Coder (CPC), Certified Medical Coder (CMC)),
• Epic certification (i.e. ARCR: Resolute Professional Billing Claims and Billing Readiness, Charge Router, or Professional Reimbursement Contracts),
• Healthcare Revenue Integrity certification (i.e. Certification in Healthcare Revenue Integrity (CHRI), National Association of Healthcare Revenue Integrity (NAHRI)), or
• Other Revenue Cycle related certification (i.e. Certified Professional Biller)
• Project Management Professional (PMP) preferred

Experience / Knowledge / Skills:

• Five (5) years of Physician/Professional Billing experience with a large health system required.
• Extensive knowledge and experience with Epic EMR system, specifically with EPIC Resolute Billing with a large health system.
• Proven analytical ability skills necessary to organize/assess information and evaluate recommendations based on data analysis.
• Excellent verbal and written communication skills to support interaction and participation in meetings with colleagues, payor representatives, and representatives of other departments within the organization.
• Advanced proficiency in Microsoft Excel and other Microsoft Business applications (i.e. Word, PowerPoint)
• Proven track record of managing details of complex, multi-faceted projects.
• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.
• Ability to organize, prioritize, and schedule work plan to meet timelines, and consider problems with multiple variables.
• Ability to informally lead and support others in a collaborative environment including training and quality assessments.
• Ability to make independent decisions when circumstances warrant; make prompt and accurate judgments.

PRINCIPAL ACCOUNTABILITIES:

• Pricing Responsibilities: Addresses issues with clinical and revenue cycle operations and facilitates resolution. Performs daily maintenance of revenue integrity work queues. Prepares methodology for annual pricing review and coding changes. Responsible for ad-hoc price adjustments. Owns pricing reviews and final implementation sign-off of pricing.
• Charge Capture Responsibilities: Ensures daily charge reconciliation. Performs daily maintenance of charge review work queues. Reports on trends, provides root cause analysis, and prepares findings with solutions for improvement. Monitors charge accuracy and compliance. Communicates with departments to resolve missing or inaccurate charge information. Addresses complex charge capture reconciliation issues and problem solves technical issues associated with missing charges.

• Data Analysis Responsibilities: Leads efforts to evaluate trends, analyzes variances, and presents findings. Prepares reports and data assessments on a scheduled frequency or ad-hoc basis. Monitors dashboards, KPIs, and operational metrics. Uses analytical approach to problem solving with quantified data and measurable results to reach sound conclusions.

• Professional Billing Responsibilities: Performs daily maintenance of fee schedule elements. Supports file development for Procedure Master File (EAP) / Fee Schedule Master File (FSC) database. Collaborates with coding, charge capture, and clinical operations to reduce revenue variances. Reviews/analyzes claim rejection report for payer patterns, rejection trends, assignment, and resolution pathways. Researches and maintains awareness of billing rules and guideline changes and suggests billing component changes as necessary for payers.

• Project Management Responsibilities: Develops plans to monitor and track project goals measures by appropriate performance metrics. Collaborates with key stakeholders to ensure reduced charge leakage and increased capture. Identifies risks and issues as they arise and establishes mitigation plan. Maintains organized project documentation and careful monitoring of project plan timelines and tasks.

• Functions as a team leader in the department by ensuring daily processes are complete, providing answers to employee questions and assisting in employee orientation and training.
• Supports all facets of professional billing revenue integrity processes to achieve and exceed best practice benchmarks.
• Partners with other departments and practices to promote consistency in processes; stays up-to-date on all regulatory billing requirements; effectively coordinates work flow to ensure optimal quality of data and timely reimbursement.
• Assists with the ongoing management of EPIC as it relates to revenue integrity and professional billing.
• Monitors work queues and reports and actively seeks for areas of opportunity, deficiencies, and improvement strategies to minimize hold lag and improve accuracy of claims.
• Establishes relationships and effectively communicates with departments and physicians, continuous improvement teams, and leadership.
• Stays informed and communicates goals, actions, and agendas to leadership, work area and patient-care staff.
• Maintains a positive cooperative relationship with all groups across billing and non-billing areas. Sets a positive example in collaborating initiatives, identifying solutions, measuring, and sharing results and providing specific feedback.
• Monitors operational controls for compliance and accountability.
• Complies with HIPAA regulations and all relevant laws, rules regulations and accreditation standards and requirements.
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.
• Other duties as assigned.