Revenue Integrity Program Manager

Partnering with a leading organization dedicated to advancing healthcare, Aquent is seeking a talented individual to join their team. This organization is at the forefront of delivering high-quality patient care, driving innovation, and ensuring the financial health necessary to support its critical mission. They foster an environment where expertise is valued, and contributions directly impact the operational excellence and strategic objectives of the institution.

Are you a seasoned expert in revenue cycle optimization with a passion for ensuring compliance and maximizing financial health within a complex healthcare environment? This pivotal role offers you the chance to directly shape financial integrity and operational efficiency, making a tangible difference in the organization's ability to provide exceptional care. You will be instrumental in identifying and resolving potential revenue leakage, while upholding the highest standards in charging and billing practices. This is an exciting opportunity to leverage your analytical prowess and leadership skills to drive meaningful improvements and ensure robust financial performance.

To be considered for this role, you must:

• Be authorized to work in the United States
• Not require sponsorship of any kind for the duration of the assignment
• Be able to work on a W-2 basis. C2C or 1099 is not permitted for this position

What You'll Do:

As a key player, you will optimize hospital and professional revenue by conducting in-depth analyses and implementing strategic improvements. You will serve as a primary liaison, collaborating directly with clinical department leaders, executive leadership, and financial administrators. Your work will involve a blend of data analytics and process improvement techniques to ensure accurate charge capture, identify improvement opportunities, and provide essential education and training in partnership with clinical leadership and the regulatory compliance team. You will also communicate findings through reports and presentations, manage intake requests, and lead critical monthly revenue integrity and financial leadership meetings.

Your contributions will be essential in:

• Charging Optimization: Conduct prospective and retrospective reviews and audits of charge capture practices within clinical departments. Report findings, provide education to providers and charge capture support staff, and coordinate charge capture improvement tools in collaboration with billing system IT teams. Report potential compliance issues for further analysis and follow-up to the regulatory compliance department.
• Charge Description Master (CDM) Optimization: Ensure a compliant and consistent Charge Description Master (CDM) system. Evaluate CDM requests with a focus on regulatory coding, compliance, and adherence to internal guidelines regarding CDM maintenance, standard naming conventions, and pricing integrity.
• Department Education: In collaboration with the regulatory compliance department, provide education to clinical department staff regarding CPT codes, HCPCS codes, revenue codes, and modifiers and their compliant use.
• Project Management: Lead projects to improve revenue capture, increase efficiencies in the charge capture process, and reduce provider burden associated with charging.
• Financial Analysis: Perform basic financial analyses to report the impact of charge capture practice changes and corrections to current practices. Communicate findings fully with clinical departments and the executive team.
• Issue Resolution: Through a combination of internal work queues, external edit platforms, and ongoing evaluation, identify charging issues and work to identify solutions.
• Performance Review: Provide ongoing reporting of revenue performance to a variety of audiences including executive leadership, faculty, financial administrators, division and clinic chiefs, and directors. Confidently present to a wide range of individuals across the organization.

Day-to-Day Tasks:

• Facilitate monthly reporting and meetings for professional services.
• Research and facilitate professional billing patient disputes.
• Process professional billing workqueues.
• Educate and facilitate professional billing clinic billing, charge code research, and workflows.
• Submit professional billing Charge Description Master (CDM) requests and collaborate with facility billing.
• Investigate professional component write-offs (e.g., related to documentation, medical necessity, untimely insurance claims, coding, and authorization issues) impacting productivity metrics.
• Answer questions from billing operations and service line management on accounts related to professional services.
• Perform and deliver ad-hoc reporting requests related to professional charges.
• Conduct productivity metric research and resolution.
• Perform professional charge reconciliation, charge corrections, posting, and audits.
• Provide provider onboarding education.
• Facilitate resolution of coding, billing, and compliance questions.
• Initiate provider profile updates.
• Update provider profiles in the billing system (may include coordination with provider enrollment, medical staff office, and advanced practice provider managers to ensure the provider is fully credentialed and able to see patients, and assign correct taxonomy and specialty codes).
• Coordinate with billing, coding, and IT teams to resolve discrepancies or system issues arising from provider profile or preference list changes, as well as billing system orders functioning with correct codes.
• Attend meetings as required.

Required Qualifications

• 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.
• Proficiency in professional billing systems and general computer systems, including Word, Excel, and PowerPoint.
• Expertise in revenue integrity for Anesthesia, Surgery Specialties, and Orthopaedic Surgery.
• 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.
• Knowledge of management and supervision, with the ability to organize staff's work.
• Strong written and verbal communication skills to articulate analyses and findings to executive leadership, financial administrators, and clinical operations leadership.
• Proven ability to provide leadership 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 and issues.
• Ability to effectively facilitate work groups towards 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.

Nice-to-Have Qualifications

• One or more of the following certifications:
• COC - Certified Outpatient Coder
• CPC-H
• CCS - Certified Coding Specialist
• CPC and/or CCSP - Certified Professional Coder
• RHIT - Registered Health Information Technician
• RHIA - Registered Health Information Administrator

The target hiring compensation range for this role is $81.96 to $87.33 an hour. Compensation is based on several factors including, but not limited to education, relevant work experience, relevant certifications, and location

About Aquent Talent

Aquent Talent connects the best talent in marketing, creative, and design with the world's biggest brands.

Our eligible talent get access to amazing benefits like subsidized health, vision, and dental plans, paid sick leave, and retirement plans with a match. We also offer free online training through Aquent Gymnasium. More information on our awesome benefits!

Aquent is an equal-opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics. We're about creating an inclusive environment-one where different backgrounds, experiences, and perspectives are valued, and everyone can contribute, grow their careers, and thrive.

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