Manager, Revenue Integrity at UT Southwestern Medical Center

Dallas, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

07 Jan, 26

Salary

0.0

Posted On

09 Oct, 25

Experience

10 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Revenue Integrity, Audit Nursing, Charge Capture, Charge Reconciliation, Billing Compliance, Data Analysis, Healthcare Regulations, Leadership, Training, Collaboration, Problem Solving, Documentation Standards, Medical Coding, Financial Services, Performance Improvement, Compliance

Industry

Higher Education

Description

WHY UT SOUTHWESTERN? With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career! JOB SUMMARY UT Southwestern has a new employment opportunity available for a Manager, Revenue Integrity within the Decision Support Department. The successful candidate in these duties will include but will not be limited to the following: Must be a Registered Nurse Provide leadership, guidance and effectively manages the day-to-day operations of the Revenue Integrity Analyst, and Audit Nurses Ensure timely review, appeal and follow up. Analyze variances, rejections, and denials information to identify problems, trends and develop feedback and reports to be presented to senior management and clinical department heads. Hospital Billing/Charge Accuracy audits (prospectively or retrospectively), Insurance Defense audits, select Focus audits, Billing Compliance and Charge Capture audits. Provides support to Patient Financial Services, HIM/Coding and departments to promote sound revenue integrity. Analyze data and develops an overall approach for trending issues, report findings, continued education and training (as the content experts) for PFS, clinical departments. The Revenue Integrity manager provides management planning, development, and guidance to staff within the roles of Audit and Chargemaster. Analyze data and develops an overall approach for trending issues, report findings, applying timely and constructive feedback, continued education, and training (as the "content experts") for Revenue Integrity, clinical departments, nursing units/depts. Prepares departments summaries based upon audit findings and works closely with applicable staff/management for continued performance improvement ensure compliance with Medicare/Medicaid regulations, Managed Care contractual agreements and the applicable policies of UT Southwestern University Hospital. BENEFITS UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include: PPO medical plan, available day one at no cost for full-time employee-only coverage 100%25 coverage for preventive healthcare-no copay Paid Time Off, available day one Retirement Programs through the Teacher Retirement System of Texas (TRS) Paid Parental Leave Benefit Wellness programs Tuition Reimbursement Public Service Loan Forgiveness (PSLF) Qualified Employer Learn more about these and other UTSW employee benefits! EXPERIENCE AND EDUCATION Required Education Bachelor's Degree from a recognized college or university in business, healthcare or a closely related field or 10 years' of experience within the revenue cycle and coding. Experience 10 years' Experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: coding, charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management or Audit Nursing and 1-year Supervisory experience Licenses and Certifications (RN) REGISTERED NURSE or (CPHT) CERT PHARMACY TECH or (PTCB) CERT COMPND STERILE PREP TECHN or (CHRI) CertHealthcareRevenueIntegrity professional certification through NAHRI or (RHIA) REGD HEALTH INFO ADMINIST professional certification through AHIMA or (RHIT) REGD HEALTH INFO TECHNOLO professional certification through AHIMA or (CCS) CERT CODING SPECIALIST professional certification through AHIMA or (COC) Certified Outpatient Coding professional certification through AAPC or (CPC) CERT PROFESSIONAL CODER professional certification through AAPC Preferred Experience EPIC HB/PB experience JOB DUTIES Oversees all revenue integrity staff with a focus on charge capture and charge reconciliation activities. Coordinates efforts with Sr. Nurse Auditor and Sr. Chargemaster Coordinator to lead audit/ charge evaluations according to RI auditing guidelines. Meets with departmental leadership to review findings, documentation standards and recommendations for improvement. Targeted populations are identified through random sampling, focused reviews, issues identified in collaboration with various site personnel, and rotation/selection of specific clinical areas. Audits include review of selected medical records documentation to determine accuracy of coding assignments, billing compliance, medical necessity and when appropriate collaborate with shared coding and financial departments to identify departments that require improved documentation. Analyzes charge capture audit reports to verify that appropriate charges have been posted to patient accounts according to diagnosis and related procedure codes and that revenue has been routed/recorded in the appropriate department/cost center. Coordinates efforts with Sr. Nurse Auditor and Sr. Chargemaster coordinator to insure all staff are informed of all regulatory changes for both hospital billing and professional billing, conduct any necessary training and all policies are kept up to date assists departments with the charge reconciliation process. Works with all relevant hospital departments and professional billing departments to provide timely education on how to correct or improve processes that have been found to be deficient. Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections for both hospital and professional billing. Stay abreast of ongoing compliance trends and developments. Reports new developments to department. Plans and presents in-services to nursing, physician, and other clinical personnel regarding processes, updates and reviews relating to audit findings and/or regulatory compliance. SECURITY AND EEO STATEMENT Security This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information. EEO UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.

Responsibilities

The Manager, Revenue Integrity oversees the day-to-day operations of the Revenue Integrity Analyst and Audit Nurses, ensuring timely reviews and appeals. They analyze variances and denials to identify trends and develop reports for senior management.