Regional Manager of Revenue Integrity and Optimization
Holy Cross Hospital
Albany, New York, 12208
6d ago

Department :

90008 84460 PFS Albany Regional Admin

Expected Weekly Hours :

Shift : Day Shift

Position Purpose :

Job Description Details :

POSITION PURPOSE

Manages revenue integrity operations for the hospital(s) and / or Medical Group Provider Services (MGPS) in the region. Provides oversight and leadership for a team responsible for, but not limited to, charge description master (CDM) maintenance, centralized charge control, pre-bill edits, appropriate revenue and reimbursement, complex claim denial coordination, payer audits and denial prevention.

Manages and monitors the audit results, data analysis and root cause issues and assists ministry departments with corrective action plans.

Responsible for building collaborative relationships with RHM leadership, PBS and other key stakeholders. Motivates and challenges staff to achieve the highest levels of performance, working in conjunction with all key stakeholders to prevent revenue deficits and maximize potential revenue for the region.

Responsible for managing the optimization of staff performance through process redesign, policy / procedure implementation, communications, continuing education and professional development activities, staff empowerment and outcome feedback.

As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve.

By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions

Manages and oversees people, systems and processes for revenue integrity, charge control functions, and the performance of standard regional revenue integrity metrics and quality.

Coordinates, synchronizes and monitors the work efforts of geographically dispersed Revenue Integrity and Charge Control work teams in order to ensure adherence to the established Standards of Excellence and ongoing monitoring of metrics and reporting of performance to senior leadership.

Facilitates and serves as a champion for process change. Works closely with Hospital Site Operations and / or MGPS leadership on implementing revenue enhancement initiatives and education.

Manages system enhancements, new programs and facility changes including analysis of impact on revenue, reimbursement and processes.

Analyzes and displays data in meaningful formats. Develops and communicates policies / procedures and other business documentation.

Manages and conducts special studies and prepares management reports, which includes Key Performance Indicators. Communicates finds to various levels of Leadership and multi-disciplinary teams.

Keeps abreast of all current payer medical policies, makes any changes to prevent loss in reimbursement, including but not limited to, Medicare and Medicaid web sites, Payer websites and newsletters for changes impacting charging, coding and billing.

Develops and provides informational education / training to team members.

Responsible for ensuring all bill-above reimbursements are identified in the contracts, implemented at time of billing, properly submitted and correct reimbursements are received.

Oversees complex case denial coordination with the Patient Business Service (PBS) centers, ensuring all actions are taken timely.

Works in conjunction with the Patient Business Service Center to create and lead local denial management team involving all revenue cycle and ancillary departments.

Meets regularly to reduce and eliminate denials; provides problem resolution and improvements to denial management vendor processes and relations.

Performs root cause analysis on denials to gather a better understanding of issues. Prepares and conducts education and training services to departments and staff pursuant to audit and root cause findings, regulatory changes and requirements, coding updates, and managed care billing requirement changes.

Manages team projects through empowerment and collaboration with team members. Fosters interdisciplinary collaborative relationships with Payer Strategies, PBS, Clinical Service lines, Physicians and other key stakeholders.

Elicits feedback from interdisciplinary team and promotes collaborative decision making as appropriate. Acts as point of contact for Revenue Integrity team obtaining and exchanging information as needed.

Provides operational guidance and direction to assigned staff to ensure service integration, effective coordination of departmental work activities, and quality job performance.

Ensures problem resolution and corrective action for long-term solutions and coordinates such effort across intra and inter-departmental channels.

Responsible for periodically assessing developmental needs of the region and promoting opportunities for skill, independent decision making, effective communication and interpersonal relations development in order to achieve and maintain top decile levels of customer satisfaction while in consideration of Trinity Health’s core values and fostering team spirit.

Collaborates with Hospital Site Operations leader(s) to identify and implement opportunities for colleagues to increase their knowledge base, advance their practice and enhance their professionalism through colleague orientation and continuing education opportunities.

Manages recruitment, some degree of training, performance, discipline and termination of positions as necessary. Works with local managers determining and managing the appropriate allocation of resources across with region.

Monitors and conducts performance appraisals and will work with Hospital Site Operations leader(s) in establishing cascading goals.

Manages regular ongoing performance feedback in a prompt, direct and positive manner. Mentor and coaches colleagues.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Other duties as assigned

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes.

We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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