Revenue Integrity Manager Epic Resolute Hospital Billing at University of Maryland Medical System in Linthicum, Maryland

Job Description:

Job Description

This is a hybrid role that will require being onsite 2-3 times per week.



Under limited supervision, the Manager of Revenue Integrity oversees and manages compliance with the Charge Description Master ("CDM") and the work of the revenue integrity team by facilitating implementation of standardized processes and accountability to support efficient and effective charge capture outcomes. Emphasis on developing annual charge capture work plans, and providing ongoing guidance/training to Revenue Integrity staff to meet their goals while ensuring that the defined processes and policies are in place to improve compliance with governmental programs, data integrity issues and related end user customer service satisfaction with the Revenue Integrity ("RI") Department (e.g. Clinical, CBO, Compliance, IT.)


The Revenue Integrity Manager oversees and validates workflows and processes to ensure accurate and timely cost / charge capture and billing compliance; directs education and training to facilitate best practices in Revenue Integrity. Recognized as an HSCRC service line subject matter expert. Proposes, implements, reviews, and modifies all work related to cost/charge capture and the CDM in compliance with HSCRC, federal, state, and local laws/regulations. Responsible for building relationships with stakeholders and uses critical thinking skills to provide systems solutions to meet business needs with guidance from the leadership team.


Manages, trains, recruits, coaches and develops Revenue Integrity Specialists within the specified functional area. Manages own time to accomplish tasks with minimal oversight, and serves as a mentor to others on the team. Conducts project management activities as required by the project, oversees applications projects, and executes projects and deliverables with general supervision.



Principal Responsibilities and Tasks



The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.


The Revenue Integrity Manager should be proficient in Resolute Hospital Billing Charge Description Master; must maintain Epic new version training requirements on an ongoing basis.


1. Manages and directs a team of Revenue Integrity professionals in accordance with departmental and UMMS personnel policies and procedures.

• Performance management responsibilities include but are not limited to: involvement in decisions and actions of hiring and termination, coaching and development, rewards and recognition, functional performance management and staff productivity. Plans, organizes, staffs, and directs the day-to-day operations of the department; develops and implements policies and procedures, as necessary.


• Coaches, mentors and develops staff, including overseeing new employee onboarding and providing career development planning and opportunities.


• Consciously creates a workplace culture that is consistent with the overall organization and that emphasizes the identified mission, vision, guiding principles and leadership values of the organization.


• Holds self and staff accountable for completion of all tasks and projects. Provides oversight of work plan functions, due dates, and preparation of deliverables.


• Empowers employees to take responsibility for their jobs and goals. Delegates responsibilities and expects accountability and regular feedback.


• Fosters teamwork and innovative thinking. Creates a spirit of teamwork and unity among department members that allows for sharing of ideas, debate and decision resolution. Builds an appreciation of diversity as well as cohesiveness, supportiveness, and working effectively together to enable each employee and the department to succeed.


• Maintains transparent communication. Appropriately communicates organization information through department meetings, regular interpersonal communications such as one-on-one meetings, email, video conferencing and IM.


• Maintains general knowledge of all functional areas within Reimbursement & Revenue Advisory Services. Serves as subject matter expert within own function.

2. Provides guidance, communication and education to multiple facilities, including regional and corporate staff on correct charge capture, billing and coding processes, and state and federal guidelines. Assists management with implementing continuous education process for departments on the importance of accurate charge capture and advises departments of effective procedures for completing the charge capture function.


3. Prepares and submits audit findings and makes recommendations to Revenue Integrity leadership team. Analyzes reports to determine areas of improvement or in need of further investigation; determines appropriate plan of action and works with department to rectify any charge capture problems. Exhibits a comprehensive knowledge of hospital specific charge capture processes to be able to effectively resolve issues.


4. Oversees the processes to establish, maintain and continuously update and monitor the accuracy of the charge master files in various hospital and clinical systems, including oversight of annual CPT and quarterly HCPCS updates, compliance to State and Federal billing / compliance regulations. Leads CDM discovery sessions as needed. Responsible for the development of system-wide CDM integration and standardization between hospitals CDM master files.


5. Coordinates external HSCRC and other CDM-related regulatory audits to ensure that all information is available and completed on a timely basis. Leads annual CDM reviews with clinical and administrative department heads. Ensures the implementation of more frequent changes comply with the changing payer requirements and HSCRC methodology and RVU task force requirements.


6. Extensive knowledge and understanding of all charge processes within the organization and provides oversight to clinical informatics staff and application analysts who assist other department managers/directors with determining compliant charge capture workflows, including updates to clinical charge capture tools.


7. Provides oversight to clinical department staff to ensure they comply with established charge capture and charge reconciliation policies and procedures.


8. Serves as an HSCRC subject matter service line expert to assist with system/process setup for new services. Keeps abreast of current regulatory information/guidelines and coaches others to do the same. Communicates relevant changes and/or protocol and procedural revisions to senior management and staff. Implements appropriate departmental operational changes to ensure compliance.


9. Actively participates in HSCRC taskforces and RVU conversions and leads implementation efforts for all UMMS affiliates.


10. Supports development, implementation and compliance of Charge Capture policies and procedures necessary to support operations.


11. Proactively assesses revenue generating departments, particularly those that are high volume, high revenue, and/or high risk to ensure accurate Charge Capture, and provides recommendations for Revenue Integrity process improvements.


12. Prepares written documentation of various types; application documentation, analytical reports, functional specifications, training manuals, status reports, etc. Creates, evaluates and instructs/teaches other analysts.


13. Prepares and validates complete applications documentation for operations and sets programming specifications for user departments. Assist in the development of departmental policies and procedures as they relate to the use of clinical applications.


14. Demonstrates an understanding of interfaces (i.e., requirements, troubleshooting, testing, etc.).


15. Troubleshoots issues, provides guidance and training or solutions to end users and seeks opportunities to optimize system software as it relates to assigned applications.


16. Provides assigned on-site support during go-lives and system upgrades.


17. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies; orients, mentors and transfers knowledge to staff.


18. Manages Revenue Integrity key performance indicators and metrics.


Company Description
The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state's future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System's anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.


Qualifications

Education and Experience

• Bachelor's Degree required. Specialization in Healthcare, Finance, Accounting or equivalent related subject is preferred.


• CPC certification required within 18 months of hire.


• Five (5) + years of progressively responsible professional financial, reimbursement, or analysis experience is required. Related internship experience may be counted toward meeting this requirement.


• Three (3) years supervisory/management experience is required.


• Minimum of two (2) years of experience in an Epic environment with proficiency in at least one Epic product preferred. Epic Resolute Hospital Billing charging proficiency required within 12 months of hire.


• Revenue Integrity/CDM build/maintenance experience required.

Knowledge, Skills and Abilities

• Expert knowledge of HSCRC & Medicare regulations is required. General knowledge of HSCRC reimbursement methodologies is preferred.


• Expert knowledge of charge master components, Epic HB Resolute functionality and familiarity with various applications.


• Highly effective at supervising, monitoring daily work activities, evaluating, training and motivating performance of subordinate technical, professional and clerical support staff.


• Knowledge of ICD-10 and AMA Current Procedure Terminology (CPT) preferred. AAPC Medical Coding certification is preferred.


• Ability to tactfully motivate and guide all levels of staff and management while maintaining required degree of confidentiality and purpose. Ability to address groups of various sizes, discuss/debate alternatives with other professionals and/or arbitrate differences of opinion and/or focus.


• Ability to facilitate stakeholder meetings, including agenda development, discussion, documentation, action item follow-up and presentation development.


• Excellent presentation, interpersonal, and negotiating skills needed to build collaborative relationships with leadership.


• Proficient organizational and problem-solving skills are required to develop/implement efficient work processes and to successfully resolve difficult, conflict-oriented situations.


• Highly effective verbal and written communication skills are necessary.


• Ability to lead and teach a project team of analysts, end users and consultants to coordinate daily activities, delegate responsibilities, tasks and review/validate work.


• Ability to teach application functionality, design standards, and problem solving tools.


• Adheres to applications security and control procedures in accordance with departmental, vendor standards and regulatory bodies. Makes recommendations as necessary.


• Expert knowledge of spreadsheets (i.e., Microsoft Excel), databases (i.e., Microsoft Access), word processing programs (i.e., Microsoft Word), graphic/ specialty and other finance-related software programs.


• Highly effective data analytic skills required. Ability to organize, combine, filter, and perform calculations on large datasets.


• Ability to handle confidential issues with integrity and discretion.


• Ability to work effectively in a stressful work environment.

Working Conditions/Physical Demands

• Position may require flexible work schedule, including night and weekend support of major implementations or major system support efforts.


• Weekend, shift work, holiday and on-call work beyond normal business hours may be required to complete projects, meet deadlines, or respond to emergencies.


• Work is performed in various environments within UMMS.


• Work may include regular travel to and from the various affiliated institutions within the Medical System.


• Work may be required in a Healthcare facility which the observance of "Universal Precautions" is mandated. Universal Precautions involves the wearing of protective clothing/equipment and the observance of safe work practice.


• Work is high demand and fast paced.


• Talking and hearing necessary for conversations with UMMS staff members.

Additional Information
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