Stanford Health Care Tri-Valley · 1 week ago
Revenue Integrity Program Manager (Remote)
United States
Full-time
Remote
Senior Level
$66.52/hr - $88.14/hr
5+ years expStanford Health Care Tri-Valley is seeking a Revenue Integrity Program Manager who will be responsible for optimizing hospital and professional revenue while ensuring compliance in charging and billing practices. The role involves working closely with clinical departments and using data analytics to identify opportunities for improvement in revenue capture.
Health CareHospitalNon Profit
Responsibilities
Charging Optimization: Conducts prospective and retrospective reviews/audits of charge capture practices in the clinical departments. Reports findings, provides education to both Providers and charge capture support staff. Coordinates charge capture improvement tools in collaboration with Revenue Cycle TDS IT teams. Reports potential compliance issues for further analysis and follow-up to the Compliance Department
CDM Optimization: Works to ensure a compliant and consistent system CDM. Works with existing tools to evaluate CDM requests with a focus on regulatory coding, compliance, and adherence to SHC internal guidelines regarding CDM maintenance, standard naming conventions and pricing integrity
Department Education: In collaboration with the Compliance Department, provides education to clinical department staff regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliance use
Project Management: Leads projects to improve revenue capture, increase efficiencies in the charge capture process, and reduce provider burden with the charging process
Financial Analysis: Performs basic financial analyses to report the impact of charge capture practice changes and corrections to current practices. Communicates findings fully with clinical departments and executive team
Issue Resolution: Through the combination of EPIC WQs, external edit platforms, and ongoing evaluation, identifies charging issues and works to identify solutions
Performance Review: Provides ongoing reporting of revenue performance to a variety of audiences including Chairs, Faculty, DFA’s, Division and Clinic Chiefs, Executive Director, Mid-Revenue Cycle, the Director of Revenue Integrity and others as appropriate. Responsible to present confidently to a wide range of individuals across the organization
Qualification
Required
Bachelor's degree in a work-related discipline/field from an accredited college or university (or equivalent combination of education/experience)
Five (5) years of progressively responsible directly related work experience
Proficient in hospital and professional revenue cycle operations
Expert in analyzing revenue data to identify trends and opportunities with the capacity to communicate findings effectively to varied audiences
Strong Interpersonal skills facilitating seamless communication with clinical staff, and faculty
Solid understanding of coding conventions and current third-party payer rules and regulations
Current knowledge of third party payer rules and regulations
Knowledge of computer systems, specifically, Epic Care and related interfaces
Knowledge of management and supervision and the ability to organize staff's work
Strong written and verbal communication skills to articulate analyses and finding to Chairs, DFAs and Clinical Operations leadership
Proven Ability to provide leadership skills in problem identification and issue resolution
Ability to influence decision-making through persuasive data-supported arguments
Ability to apply critical thinking skills to complex issues and situations
Competence in mediating and solving intricate work problems
Ability to effectively facilitate work groups towards to successful outcomes
Ability to facilitate stakeholder meetings, including agenda development, discussion, documentation, action item follow-up and presentation development
Strong organizational skills and attention to detail, with the ability to manage multiple priorities effectively
Preferred
Non Clinical COC - Certified Outpatient Coder preferred
CPC-H preferred
CCS - Certified Coding Specialist preferred
CPC and/or CCSP - Certified Professional Coder preferred
RHIT - Registered Health Information Technician preferred
RHIA - Registered Health Information Administrator preferred
Company
Stanford Health Care Tri-Valley
STANFORD HEALTH CARE TRI-VALLEY Stanford Health Care Tri-Valley (formerly ValleyCare) provides high-quality care rooted in science and compassion to support the health and well-being of its community in the East Bay and beyond.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Reena Jadhav
Board Member, Chair Comp & Workforce
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