Connecticut Children's · 9 hours ago
Manager, Revenue Integrity - 40hrs
East Hartford, CT
Full-time
Onsite
Senior Level
7+ years expConnecticut Children's is the only health system in Connecticut that is 100% dedicated to children. The Manager of Revenue Integrity is responsible for optimizing workflows related to documentation, charges, and coding of services, while ensuring compliance with government and payer regulations.
Health CareHospitalMedical
Responsibilities
Helps ensure adequate training and education occurs to both providers and hospital departmental staff regarding accurate charge capture and documentation requirements
Oversees Charge Reconciliation, CDM Management and Charge Capture processes and training materials
Oversees CDM maintenance and development, including correct coding and charging, updating of pricing, adding new service lines, inactivating unused CDM service lines within established organizational Policy and Procedures. Works directly with managers and other key staff of revenue producing departments to identify billable services, and establish the charge process
Develops, documents, and maintains effective charging policy, procedures and training materials (as needed), for the organization
Participates in research of billing and coding requirements when new procedures and/or supplies are introduced. If appropriate to bill for new services, ensures related systems are set up correctly, tested, and monitors initial charging of services for proper billing as well as following claims for initial reimbursement
Collaborates with clinical leaders and others to review and evaluate new technologies and formulary items and establishes related documentation, charge capture, and coding protocols
Liaises with key stakeholders including Finance Departments, Compliance, HIM, Coding, CDI, Clinical Departments, Information Technology, as well as others
Facilitates the dissemination of information regarding government and third-party payer regulations and requirements to clinical departments, providers, management and staff, as applicable
Oversees communication of coding and billing updates published in third-party payer newsletters/bulletins and provider manuals to all stakeholders as appropriate
Works collaboratively with Professional Coding, Facility Coding and Compliance (when indicated) with performing appropriate reviews, investigating trends and patterns, and providing education regarding documentation, charge capture, charge reconciliation, billing/coding guidelines and denials. Ensures reviews are conducted on an annual basis and/or as otherwise identified, in all areas treating patients to ensure all professional and facility billable charges are captured and coded completely and accurately, and documentation reflects same
Maintains knowledge of government and third-party payer audits and participates in denials prevention activities
Maintains a revenue optimization database, communicates and coordinates resolution of opportunities. Presents and communicates findings, trends, mitigation efforts and recommendations to established Committees and key stakeholders
Assists and makes recommendations for third-party payer contract language related to clinical coding standards and requirements. Participates in internal and external contracted payer discussions and negotiations regarding clinical coding and charging standards when needed
Develops and monitors metrics to ensure functions of the Revenue Integrity team are performed efficiently as well as with a high degree of accuracy and customer service
Coordinates external reviews for focused assessments as well as information system software review (CDM, Supply, Medications)
Demonstrates support for the mission, values and goals of the organization
Qualification
Required
Bachelor's degree in Healthcare related field, Master's Degree Preferred. May maintain an Associate's degree with 10+ years' experience directly related to healthcare and Revenue Integrity in lieu of a Bachelor's degree
Seven years minimum recent and direct related experience. Previous management experience in Clinical service area(s), Revenue Integrity, Revenue Cycle Area(s)
Active Certified Coding Specialist (CCS) and/or Certified Professional Coder and/or Certified Outpatient Coder and/or Hospital (CPC-H) (or attainment within one (1) year of hire)
Extensive clinical coding knowledge; clinical experience preferred
Solid understanding of the reimbursement systems including IPPS, OPPS, DRG, etc
State and federal and third party payer regulations
CPT/HCPCS/ ICD classification, medical terminology, billing and reimbursement processes
Extensive knowledge of charge creation, processing and reconciliation in a health care environment
Strong quantitative, analytic, and problem-solving skills
Strong organizational skills
Strong time management, attention to detail, and follow through
Excellent interpersonal and communication skills
Microsoft Office, Outlook, Excel; Epic experience highly desirable
Well developed, formal presentation skills
Effectively collaborate with providers and staff at all levels
Manage day to day operations managing staff and ensuring efficient workflows
Analyze and interpret billing guidelines, state, federal and third party payer regulations
Organize resources and establish priorities
Develop, plan and implement short and long-range goals
Foster a cooperative work environment
Effectively manage staff, ensure employee development and oversee performance management
Preferred
Master's Degree
Previous clinical experience
Dual Certifications i.e., CPC and CCS
Company
Connecticut Children's
Connecticut Children’s is a leading pediatric academic medical center consistently ranked by our peers as among the best children’s hospitals in the nation.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$0.25M2014-04-07Grant· $0.25M
Leadership Team
Jim Shmerling
President and CEO
Bob Duncan
Executive Vice President and Chief Operating Officer
Recent News
Hartford Business Journal
2026-01-14
Hartford Business Journal
2025-12-30
Hartford Business Journal
2025-10-31
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