UF Health
Manager Revenue Guardian | Revenue Integrity | Days | Full-Time
UF Health, Gainesville, Florida, us, 32635
Overview
The Revenue Guardian Manager will directly manage the Revenue Integrity Guardian/Auditing Unit of the Revenue Integrity Department, to improve coding, develop and execute project plans, gather/analyze data and improve billing processes, payer defense audits, collaborate with all of Revenue Cycle leaders on findings and revenue improvement initiatives, while providing team leadership, mentoring and supervision. This position will manage a highly skilled group of staff that have a direct impact on revenue leakage and over revenue cycle improvements.Responsible for managing the Revenue Integrity Guardians and Auditors performance to assure timely, accurate and compliant charging and billing.Develop and implement policies and procedures.Monitor statistics and KPI s to identify and implement improvement opportunities.Develop and maintain a work plan to regularly reconcile charges.Plans and coordinates monitoring and maintenance of CDM and respective departments, including but not limited to appropriate billing of charges, proper assignment of billing codes based on a consistent markup of cost in accordance with regulatory requirement and policies and procedures. Works with key stakeholders to identify charge capture opportunities and implement controls necessary to maximize revenue.Ensures the timely and accurate response to ADR, CERT, PERM, RAC, audit defense and other third-party payer audit requests.Monitor functions and activities to safeguard against exposure to penalties and fines by ensuring healthcare services are billed accurately and properly at all times.Responsible for the knowledge of, analysis and communication of potential impact of regulatory changes on the Hospital revenue and various charge capture projects.Identifies relevant regulatory and contractual terms, communicates/educates and directs actions as appropriateIncorporates knowledge of reimbursement rules, regulations, and policy. Serve as technical advisor on reimbursement issues as they develop by utilizing knowledge of coding and billing regulations.Coordinate efforts of multi-disciplinary groups responsible for projects involved in the management, enhancement and education of revenue and reimbursement and shall work closely with other departments (i.e. hospital service departments, Accounting, Coding, HIM, Billing, Utilization Management, Compliance, Information Systems and Finance) to conduct departmental process improvement projects for the benefit of charge capture and revenue integrity.Ensures the placement of controls holding providers and hospital departments accountable for effectively managing the denial management and charge capture processes. Oversees the dissemination of information regarding charging, coding and reimbursement to stakeholders across UFH. Perform other job-related duties as assigned by the Director of Revenue Integrity and Executive Director of Revenue Cycle OperationsQualifications
Minimum Education and Experience Requirements: Bachelor's Degree in Business or Healthcare Field required; Master's Degree preferred. Coding certification in at least one of the following: CPC, CPC-P, CPC-H or Certification in Auditing and/or Healthcare Compliance preferred. Requires five (5) years with hospital reimbursement or revenue cycle/charge capture Require 3+ years of supervisor experience Must have in-depth knowledge of hospital Charge Description Master (CDM), and/or billing and hospital inpatient and outpatient coding Must have working knowledge of current Medicare and other regulatory billing guidelines. Must possess competency with personal computers, possessing working knowledge of Excel, Word, PowerPoint, Access, and mainframe programs. Excellent analytical and interpersonal skills, written and oral communication skills required. Ability to collaboratively coordinate, set priorities, operate with minimal direct supervision Must have the ability to work with a wide range of staff as part of interdisciplinary team Must have problem solving and process skills Requires extensive data mining and abstracting of financial and clinical information from various decision support tools for, but not limited to, charge master support, revenue and reimbursement analyses and ad hoc reporting needs of department. Motor Vehicle Operator Designation: None provided Licensure/Certification/Registration: None
The Revenue Guardian Manager will directly manage the Revenue Integrity Guardian/Auditing Unit of the Revenue Integrity Department, to improve coding, develop and execute project plans, gather/analyze data and improve billing processes, payer defense audits, collaborate with all of Revenue Cycle leaders on findings and revenue improvement initiatives, while providing team leadership, mentoring and supervision. This position will manage a highly skilled group of staff that have a direct impact on revenue leakage and over revenue cycle improvements.Responsible for managing the Revenue Integrity Guardians and Auditors performance to assure timely, accurate and compliant charging and billing.Develop and implement policies and procedures.Monitor statistics and KPI s to identify and implement improvement opportunities.Develop and maintain a work plan to regularly reconcile charges.Plans and coordinates monitoring and maintenance of CDM and respective departments, including but not limited to appropriate billing of charges, proper assignment of billing codes based on a consistent markup of cost in accordance with regulatory requirement and policies and procedures. Works with key stakeholders to identify charge capture opportunities and implement controls necessary to maximize revenue.Ensures the timely and accurate response to ADR, CERT, PERM, RAC, audit defense and other third-party payer audit requests.Monitor functions and activities to safeguard against exposure to penalties and fines by ensuring healthcare services are billed accurately and properly at all times.Responsible for the knowledge of, analysis and communication of potential impact of regulatory changes on the Hospital revenue and various charge capture projects.Identifies relevant regulatory and contractual terms, communicates/educates and directs actions as appropriateIncorporates knowledge of reimbursement rules, regulations, and policy. Serve as technical advisor on reimbursement issues as they develop by utilizing knowledge of coding and billing regulations.Coordinate efforts of multi-disciplinary groups responsible for projects involved in the management, enhancement and education of revenue and reimbursement and shall work closely with other departments (i.e. hospital service departments, Accounting, Coding, HIM, Billing, Utilization Management, Compliance, Information Systems and Finance) to conduct departmental process improvement projects for the benefit of charge capture and revenue integrity.Ensures the placement of controls holding providers and hospital departments accountable for effectively managing the denial management and charge capture processes. Oversees the dissemination of information regarding charging, coding and reimbursement to stakeholders across UFH. Perform other job-related duties as assigned by the Director of Revenue Integrity and Executive Director of Revenue Cycle OperationsQualifications
Minimum Education and Experience Requirements: Bachelor's Degree in Business or Healthcare Field required; Master's Degree preferred. Coding certification in at least one of the following: CPC, CPC-P, CPC-H or Certification in Auditing and/or Healthcare Compliance preferred. Requires five (5) years with hospital reimbursement or revenue cycle/charge capture Require 3+ years of supervisor experience Must have in-depth knowledge of hospital Charge Description Master (CDM), and/or billing and hospital inpatient and outpatient coding Must have working knowledge of current Medicare and other regulatory billing guidelines. Must possess competency with personal computers, possessing working knowledge of Excel, Word, PowerPoint, Access, and mainframe programs. Excellent analytical and interpersonal skills, written and oral communication skills required. Ability to collaboratively coordinate, set priorities, operate with minimal direct supervision Must have the ability to work with a wide range of staff as part of interdisciplinary team Must have problem solving and process skills Requires extensive data mining and abstracting of financial and clinical information from various decision support tools for, but not limited to, charge master support, revenue and reimbursement analyses and ad hoc reporting needs of department. Motor Vehicle Operator Designation: None provided Licensure/Certification/Registration: None