Job Description

The Revenue Integrity Manager will oversee the denials management process within the revenue cycle, ensuring efficient and effective resolution of claim denials from payers. This role will focus on leading a team dedicated to the operational aspects of denials resolution, including appeal writing, follow-up, and implementing strategies to minimize future denials. The manager will collaborate with various departments to promote best practices and uphold revenue integrity.



Oversight of Denials Management Team + Lead and manage a team focused on resolving claim denials. Provide guidance and support in daily operations, fostering a collaborative environment
+ Establish and monitor productivity measures for assigned personnel; ensure that the operational workflow of denials management is distributed for efficiency and accuracy
+ Perform personnel management functions to include but not limited to personnel scheduling, timecard approval, candidate screening, interview and selection, and involvement with personnel performance improvement actions
+ Oversee the appeal writing and submission process, ensuring timely and accurate responses to denials. Establish metrics for success and track performance
Leadership of Denial Management and Recovery Operations + Analyze denial trends and root causes to develop targeted strategies for resolution and prevention. Present findings and recommendations to upper management and stakeholders
+ Develop and maintain key performance indicators (KPIs) related to denial rates and resolution times
+ Identify patterns and trends in denials to inform departmental strategies and improve processes
+ Collaborate with various departments, including billing, coding, and clinical teams, to gather information and insights
+ Collaborate with billing, coding, and clinical staff to gather necessary information for effective resolution
Training and Education + Develop standard and repeatable denials education programs
+ Provide ongoing training sessions for staff on resolving denials and enhancing workflow practices to support the resolution of denials
+ Provide training and ongoing education to staff regarding denial management processes, appeal writing, and changes in payer requirements
Policy and Workflow Development + Contribute to developing and refining departmental billing and denial management policies
+ Contribute to developing and refining operational workflows related to documentation, accurate charge capture, billing, and denial management
Continuous Improvement + Identify opportunities for process improvement within the claims resolution cycle and promote best practices to enhance revenue integrity
Serves a key role in the Denials Task Force and other denials prevention work groups

Education Requirements

Required: Associates degree in Health Administration, Finance, Business Administration, or a related field. In lieu of an Associates degree, an additional five years of experience in revenue cycle management beyond the minimum experience required may be considered


Preferred: Bachelors degree in Health Administration, Finance, Business Administration, or a related field

License or Certification Requirements

Preferred: Certification


Certification through the Healthcare Financial Management Association (HFMA), American Health Information Management Association (AHIMA), or other similar industry organizations

Experience Requirements

Required: 5 years


With an Associates degree, at least five years of revenue cycle management or other management experience is required. Without an Associates degree or other advanced degree, at least ten years of revenue cycle management or other management experience is required

Core Competencies

Knowledge:


Strong understanding of medical billing and coding practices Familiarity with healthcare regulations and payer processes Experience with electronic health record (EHR) systems and revenue cycle management software Strong knowledge of Microsoft Office applications
Skills:


Analytical Skills: The ability to analyze large data sets, determine trends, synthesize results, and deliver prioritized details through effective reporting Communication Skills: Strong communication and interpersonal skills for effective collaboration and education Problem-Solving Skills: The capacity to understand issues, derive many potential solutions, troubleshoot discrepancies, and understand systematic approaches to problem resolution
Abilities:


Attention to Detail: Precision is essential when reporting critical analysis to inform decision-making and operational change Time Management: Managing multiple tasks and deadlines while prioritizing work is essential in a fast-paced healthcare environment Technology Proficiency: Beyond EHR systems, familiarity with various billing software and technology tools
Work Environment: This position may involve working in a variety of clinical and administrative settings, requiring adaptability and a proactive approach to problem-solving.


Physical Demands: Frequent reaching, sitting, walking, and standing may be required. No special coordination beyond that used for normal mobility and handling of everyday objects and materials is needed to perform the job.