Manager - Revenue Integrity

JOB SUMMARY:

The Manager - Revenue Integrity oversees Sidra's database of service offerings, codes, rates, pricing and ongoing Chargemaster maintenance and also manages the adherence to coding and workflows around professional and technical fee coding as it relates to finance and the chargemaster.  The Manager – Revenue Integrity ensures the management of Revenue Cycle initiatives associated with Charge Capture, Charge coding and Charge Reconciliation.  This position will manage all aspects of Charge Description Master (CDM), including but not limited to development of new charge codes, compliance with third party coding regulations, revision of existing codes, CPT/HCPCS updates, revenue code changes, pricing, and maintaining compliance with current local regulations as well as payer requirements.  The Manager – Revenue Integrity is also responsible for developing, implementing and monitoring a charge audit/capture/reconciliation process and ensuring charges are maximized for reimbursement.

KEY ROLE ACCOUNTABILITIES:

• Ensures that Sidra’s patient billing practices are in compliance with national requirements.
• Oversees Rates and Charge Description Master staff. Ensures that CDM is mapped appropriately to the charge capture mechanisms in the Cerner system.
• Manages and conducts financial reviews to determine charge capture accuracy and comprehensiveness.
• Responsible for the effective and efficient operation of Sidra’s Charge Description Master services and related processes.
• Works with Sidra departmental managers to ensure that clinical charges and billing codes are fully and correctly established in Cerner’s patient care applications and are captured by Cerner’s patient billing applications.
• Ensures that Sidra’s patient billing practices are in compliance with private insurance carriers and national requirements.
• Oversees Rates and Charge Description Master staff.
• Ensures the accuracy and completeness of all coding systems with the CDM, which may include DRG’s, CPT’s HCPCS, etc. 
• Participates in the establishment of Sidra’s pricing methods and structures.
• Oversees the provision of price estimates for procedures or services to clients and insurance companies.
• Manages and conducts financial reviews to determine charge capture accuracy and comprehensiveness.
• Liaises with Sidra other members of Sidra’s Patient Billing and Insurance team as necessary.
• Leads efforts of multidisciplinary groups where necessary to monitor the completeness and accuracy of charge capture, revenue and billing data.
• Actively promotes and participates in initiatives to improve organization effectiveness and efficiency.
• Responsible for ensuring accurate and timely reports are prepared on a regular and as needed basis.
• Responsible for the ongoing training and development of staff.
• Provides education as needed to departments related to their charges and charging practices.
• Performs audits of charging practices for compliance across the facility.
• Maintains all documentation related to the CDM.
• Attends finance and staff meetings as required.
• Adheres to Sidra’s standards as they appear in the Code of Conduct and Conflict of Interest policies
• Adheres to and promotes Sidra’s Values

QUALIFICATIONS, EXPERIENCE AND SKILLS:

• 5+ years relevant experience at a management level
• CDM Experience in a complex acute care organization similar to Sidra

• Experience in a start-up environment
• Experience in implementing patient billing and accounting systems
• Experience with Cerner

• Certified Professional Coder (CPC)
• Certified Patient Account Manager (CPAM)

• Demonstrated knowledge of patient billing systems, health procedures and classification systems, 
• Strong understanding of various reimbursement methodologies with expert knowledge of payer billing requirements.
• Demonstrated knowledge of hospital accounting systems and practices as related to patient billing
• Advanced problem solving skills
• Proficiency with Microsoft Office suite
• Fluency in written and spoken English

Fluency in written and spoken Arabic is preferred