Revenue Integrity Manager

ABOUT AUSTIN REGIONAL CLINIC:

Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 10 years! We are one of central Texas’ largest professional medical groups with 25 locations and we are continuing to grow. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit https://www.austinregionalclinic.com/careers/

PURPOSE

Under general supervision of the Revenue Integrity Director, is responsible for daily supervision of the Revenue Integrity team. Manages the coding function for assigned area(s), including coding production, coder education and quality, clinician support, productivity, risk-mitigation, physician education, partnerships and/or coding systems support. Develops and implements best practices to enhance the accuracy of coding for billing, benchmarking, outcomes, and operational purposes. Investigates obstacles within the revenue cycle including but not limited to registration, scheduling, check-in, charge review, and claims. Ensures compliance with state and federal regulations, as well as support revenue cycle goals. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

ESSENTIAL FUNCTIONS

• Uses key performance indicators to improve Operations and Central Business office performance.
• Ensures that coding practices are standardized system-wide and consistent with regulatory requirements.
• Documents all coding procedures and guidelines in writing and ensures all coding caregivers adhere to them.
• Identifies opportunities for process and quality improvement based upon analysis and review of current practices.
• Represents Revenue Cycle Leadership regarding coding and revenue cycle best practices and issues with other department leadership, vendors, government agencies, and/or clinical providers. Works directly with Compliance & Risk Leadership to research and resolve issues. Provides updates to relevant committees and leaders on complex coding issues, current status compared to goals and significant future developments.
• Manages practice management system’s performance to reduce errors, reduce work and improve through-put, accelerate cash flow, and to increase net revenue.
• Leads team in finding revenue leakage, process improvements, departmental education opportunities and denial management efforts.
• Works closely with Operations Directors and departments to ensure compliance and accuracy in charge capture and billing.
• Works closely with Central Business Office departments on timeliness of billing activities, issues, and trends.
• Works closely with departments throughout the company to streamline procedures related to the revenue cycle process to achieve the effectiveness, efficiency and accuracy of the billing effort.
• Conducts monthly meetings with staff and shares relevant information from external meetings with staff.
• Works directly with Revenue Integrity Supervisor to ensure scope and timeliness of the unit’s projects.
• Assists with the development of budgets and monitoring of department operations to achieve goals within budget.
• Plans, implements and evaluates training and educational programs based on the department’s goals, regulatory or system changes. Identifies training opportunities and areas of improvement to aid in the development of training courses and reference tools.
• Ensures all certified coders are properly trained to national standards, the information is consistent system wide, and caregivers are regularly informed about external and internal updates, developments and/or issues.
• Institutes, monitors and holds all certified coders accountable to quality and productivity standards.
• Tracks, analyzes and benchmarks data to peer groups, identifying trends and/or opportunities to improve.
• Establishes, implements and maintains a formalized revenue cycle review and audit process, including the maintenance of all documentation. Ensures audits are conducted and in line with the established coding audit methodologies.
• Assesses compliance activities, together with the Compliance & Risk department, by identifying areas of high-risk and mitigating those risks factors system-wide.
• Collaborates with Revenue Cycle Leadership and Compliance Officers in all aspects of identification, evaluation, reporting and corrective action for any reported or potential risks or violations identified.
• Ensures internal controls are maintained to reduce the potential for error in such areas as the chargemaster and procedure codes set up.
• Assists with coordinating efforts of groups responsible for projects involved in coding, charge capture, billing, compliance, information systems, finance and accounting
• Coordinates priorities, workflows, and schedules between requesting departments, executives and responsible teams.
• Uses data analytics and workflow assessments to recommend workflow enhancements to departments throughout the company.
• Assesses patient experience cycle beginning from appointment scheduling to claim adjudication and patient payment.
• Assures billing systems and process requirements are in order to ensure timely and optimal reimbursement.
• Assists the organization in operating according to industry benchmarks, A/R performance goals and staff productivity.
• Supports the coding denial and appeal processes.
• Monitors on a regular basis the timely review and response to any third party payer notification of incorrectly coded claims and denial rates, appeal rates, success ratio and dollars lost or recovered.
• Actively involved in designing, maintaining, testing and implementing automation to assist departmental operations to the greatest capacity.
• Regular and dependable attendance.
• Follow the core competencies set forth by the organization, which are available for review on CMSweb.

OTHER DUTIES AND RESPONSIBILITIES

• Attends system meetings as invited.
• Collaborates effectively with centralized management teams to share best practice and support operational goals.
• Engages in organizational development through meeting attendance and committee involvement.
• Adapts schedule as needed in order to meet deadlines, including overtime and evening/weekend hours.
• Performs other duties as assigned.

QUALIFICATIONS

Education and Experience

Required: Bachelor’s degree in healthcare, finance or related area or three-to-five (3-5) years’ equivalent knowledge. Five (5) or more years of related experience working in coding, health information management and/or compliance for a large complex health care system, to include two (2) or more years of supervisory experience in health information, clinical, operational or coding function.

Preferred:

Knowledge, Skills and Abilities

• Excellent understanding of medical terminology, anatomy, and physiology.
• Demonstrates skills in financial and statistical analysis, and project management.
• Demonstrates knowledge of third party reimbursement programs, state and federal regulatory issues and ICD, CPT, and/or HCPCS coding.
• Ability to work effectively with all levels across multiple departments, using strong influencing and negotiation skills.
• Strong knowledge in business office functions and ability to serve as a resource to staff.
• Knowledge of practice management systems.
• Proficient computer skills and knowledge of Microsoft Excel and Access programs.
• Knowledge of and/or experience with procedural and diagnostic coding.
• Ability to train and monitor staff to ensure compliance with federal, state and local regulations and established practices; implements new policies/procedures and keeps employees abreast of current changes and standards as they relate to business needs.
• Ability to actively manage work queues and staff accordingly.
• Ability to analyze problems, make decisions, and manage conflict.
• Ability to interpret call reporting and identify anomalies to be addressed.
• Ability to engage others, listen and adapt response to meet others’ needs.
• Ability to align own actions with those of other team members committed to common goals.
• Excellent verbal and written communication skills.
• Ability to manage competing priorities.
• Ability to perform job duties in a professional manner at all times.
• Ability to understand, recall, and communicate, factual information.
• Ability to understand, recall, and apply oral and/or written instructions or other information.
• Ability to organize thoughts and ideas into understandable terminology.
• Ability to apply common sense in performing job.

Certificate/License

One or more of the following certifications/registrations required:

• Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA)
• Coding Specialist – Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA)
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA)
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA)
• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC)
• Health Data Analyst (CHDA) certification issued by the American Health Information Management Association (AHIMA).

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• Do you have a certification in coding or health management?

Experience:

• coding, health information management and/or compliance: 5 years (Preferred)
• supervisory: 2 years (Preferred)

Work Location: In person