Manager, Revenue Integrity_

Silver Spring

**Employment Type:**

Full time

**Shift:**

Day Shift

**Description:**

General Summary:

Responsible for planning, directing and managing revenue integrity operations for Holy Cross Health. Responsible for motivating staff to achieve the highest levels of performance, working in conjunction with all key stakeholders to prevent revenue leakage and maximize potential revenue for the region. Manages the Charge Description Master (CDM), resolution of pre-bill edits, root cause analyses, and denials coordination with the Trinity Health Enterprise Patient Financial Services (EPFS) team, which includes complex case denials, denial prevention, audits, and education and training of multi-disciplinary hospital and/or Medical Group Provider Services (MGPS) teams. Responsible for optimizing staff and overall revenue performance through process redesign, policy/procedure implementation, communications, continuing education and professional development activities, staff empowerment and feedback. Responsible for providing report development, analytical, process redesign and performance improvement support to managers as needed to support accurate, consistent and compliant revenue operations. Responsible for ensuring that Trinity Health standard information systems and policies implemented at Holy Cross Health support Maryland-specific regulatory needs and Maryland Health Services Cost Review Commission (HSCRC) charging and reimbursement guidelines.

The Manager is responsible for compiling and monitoring revenue performance indicators against operating plan and established targets and providing analytical and strategic leadership to improve performance to established targets. Achieves success through promotion of effective design, measurement and analysis of key processes and outcomes. Collaborates with local leadership and clinical staff, as well as leaders and colleagues from Trinity Health Integrity and Compliance, Revenue Site Operations, EPFS and other Revenue Excellence leaders to accomplish key performance goals, implement process improvement and other strategic initiatives, and identify opportunities for improvement through the integration of people, process, and technology. Acts as a change leader, systematically driving and implementing change throughout Holy Cross Health allowing for optimal revenue performance.

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.

**Job Title:**

Revenue Integrity, Manager

**Employment Type:**

Full-Time

**Shift:**

Days

**(SUMMARY) Position Highlights:**

+ **Competitive pay**

+ **Additional Benefits:** tuition reimbursement, free parking, employee discounts

+ **Quality of Life:** Flexible work schedules

+ **Advancement:** professional growth within the organization

+ **Location:** Holy Cross Health has two hospitals and four healthcare centers all a short driving distance from Washington DC and Baltimore, MD.

**Description:**

+ Monday-Friday

+ The Manager is responsible for compiling and monitoring revenue performance indicators against operating plan and established targets and providing analytical and strategic leadership to improve performance.

**Responsibilities:**

+ Responsible for planning, directing and managing revenue integrity operations for Holy Cross Health.

+ Responsible for motivating staff to achieve the highest levels of performance, working in conjunction with all key stakeholders to prevent revenue leakage and maximize potential revenue for the region.

+ Manages the Charge Description Master (CDM), resolution of pre-bill edits, root cause analyses, and denials coordination with the Trinity Health Enterprise Patient Financial Services (EPFS) team, which includes complex case denials, denial prevention, audits, and education and training of multi-disciplinary hospital and/or Medical Group Provider Services (MGPS) teams.

+ Responsible for optimizing staff and overall revenue performance through process redesign, policy/procedure implementation, communications, continuing education and professional development activities, staff empowerment and feedback.

+ Responsible for providing report development, analytical, process redesign and performance improvement support to managers as needed to support accurate, consistent and compliant revenue operations.

+ Responsible for ensuring that Trinity Health standard information systems and policies implemented at Holy Cross Health support Maryland-specific regulatory needs and Maryland Health Services Cost Review Commission (HSCRC) charging and reimbursement guidelines.

+ Other duties as assigned by regional director, Maryland Hospital Site Operations.

**What you will need:**

+ Bachelor's degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field.

+ Must possess a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes and audits, and clinical billing experience.

+ Proficiency with MS Excel, Access, Business Objects highly desired, and strong level of competency with Word and PowerPoint.

+ Minimum of three (4) years of management experience in a multi-facility, integrated health care delivery system or revenue cycle/revenue integrity consulting experience.

+ Minimum of five (5) or more years of progressive experience in revenue cycle operations and related healthcare regulatory requirements governing billing of hospital and/or provider services. Experience in implementing new processes and procedures to ensure compliance with regulatory requirements.

+ Knowledge of the Maryland acute care reimbursement system and its impact on prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Not Final Billed (DNFB) account resolution.

+ The ability to organize and present information in a concise and meaningful way using flowcharts, process maps, summaries and presentation formats. Proficient in spreadsheet and graphing capability for analyses and presentation of material. Experienced with data collection, analysis, and providing written reports, proposals incorporating findings.

+ Experience in Charge Description Master (CDM) maintenance or oversight preferred.

+ Must possess demonstrated knowledge of process improvement techniques and their application. Must possess ability to lead implementation and process improvement projects with minimal supervision. Ability to manage multiple projects simultaneously.

+ Demonstrated leadership ability and a record of effective, team-oriented relationships with hospital and medical staff at all levels and a track record of success in facilitating the work of teams and committees.

+ Ability to prioritize and deliver on key initiatives; demonstrated success in achievement of key performance metric targets within time and budget constraints.

+ Ability to manage diverse staff in a learning environment with frequent changes in departmental priorities. Ability to recognize necessary changes in priority of tasks and allocation of resources, and act upon them as required to meet workload demands.

+ Ability to understand and interpret complex issues and clinical processes and recommend improvements.

**About us:**

Holy Cross Health is a Catholic, not-for-profit health system that serves more than 240,000 individuals each year from Maryland's two largest counties — Montgomery and Prince George's counties. Holy Cross Health earns numerous national awards, clinical designations and accreditations across a wide range of specialties for providing innovative, high-quality health care services. We were named one of America’s 100 Best Hospitals for 2021.

_Holy Cross Health is an Equal Employment Opportunity (EEO) employer. Qualified applicants are considered for employment without regard to Minority/Females/disabled/Veteran (M/F/D/V) status_

**Our Commitment to Diversity and Inclusion**

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 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.

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

EOE including disability/veteran