Position Summary:

　　The System Manager of Revenue Integrity (RI) is responsible for assisting with planning, directing, organizing, monitoring, and staffing departmental services subject to policies, budgets, objectives, and directives mandated by regulatory agencies, DNV and the executive team. Supports the revenue for the health system, through maintaining a compliant and defensible ChargeMaster (CDM), claim integrity and charge reconciliation program. Provides department and organizational training and education to promote the overall integrity of the CDM program. Works closely and collaboratively with all revenue cycle functions, HIM, IT, compliance, finance, and clinical departments. Research, develop, and conduct training regarding RI related issues.

　　Minimum Qualifications:

　　Bachelor’s degree in business related field, accounting, or equivalent of five successful years’ related experience

　　Three (3) years of experience in ChargeMaster role, or Healthcare Charge Equivalent

　　Five years of managerial experience

　　Prior experience with Epic

　　Regulatory knowledge required for PPS and CAH Hospital, Provider-Based, Free-Standing Clinic, Swing Bed Billing, and Payor Enrollment

　　Working knowledge of Coding and Payment Classification Systems, i.e. ICD-10, HCPCs, CPT, OPPS, IPPS, MPFS

　　Preferred: Coding Certificate; Certified Provider Credentialing Specialist (CPCS)

　　Preferred: Master’s degree in healthcare administration or business administration or related field.

　　Preferred: Five years’ experience in Charge Master role

　　Essential Job Functions:

　　Provides Leadership to RI operations to ensure the provision of comprehensive departmental services in compliance with all regulatory agencies and organizational requirements

　　Ensures the accurate development and submission of claims to support reimbursement, including timely filing requirements in collaboration with applicable leaders

　　Monitors RI key performance indicators, i.e. specific candidate for billing, revenue guardian edits, charge related edits, accounts receivable days, and applicable WQs

　　Develops and analyzes reports/dashboards to summarize RI and charge related trends to applicable committees, work groups and department leaders

　　Collaborates with the system director to ensure a departmental approach to long-range strategic operational planning, care and service design and development of organizational policies, which reflect the mission of the organization and budget goals

　　Facilitates an accurate and timely CDM update as required by annual CPT and BH budget requirements, i.e. price increase in collaboration with IT

　　Creates and maintains accurate fee schedules, i.e. client billing, professional billing, hospital billing

　　Establishes internal quality monitoring program of the CDM to include external reviews and internal monitoring including the development of a plan to address opportunities identified

　　Facilitates the request to make changes or updates to the CDM and ensures the accurate processing of such requests

　　Maintains RI third-party applications in partnership with IT

　　Oversees and facilitates the Revenue Reconciliation program for BH, including departmental education and accountability, chairs the Revenue Reconciliation Committee

　　Oversees the payor enrollment function to ensure timely enrollment to reduce gaps in payor reimbursement, i.e. facility and individual provider enrollment

　　Collaborates with medical staff office, human resources, and applicable operational leaders to support the payor enrollment function

　　Coordinates and oversees the organization-wide departmental services. Continuously assesses, measures and improves departmental performance

　　Demonstrates responsible management of all departmental resources

　　Demonstrates clinical/technical and managerial competency. Ensures staff professional needs are met

　　Assesses current staffing model to determine if the function is resourced appropriately

　　Leads, teaches, inspires, helps and consistently demonstrates hospital behavioral standards

　　Knowledge, Skills and Abilities

　　Strong leadership managerial skills; ability to plan, delegate, monitor and improve work performance

　　Demonstrates sound judgement, patience, and maintains a professional demeanor at all times

　　Demonstrates ability to escalate issues to system director and provide solutions to issues as they arise

　　Ability to work in a fast-paced environment

　　Strong interpersonal, verbal and written communication skills

　　Creativity, problem analysis and decision making

　　Exercises tact, discretion, sensitivity and maintains confidentiality

　　Detail oriented, organizational skills and the ability to prioritize

　　Standard office equipment and computer applications; MS Office, EMR, internet applications etc.

　　Intermediate level MS Excel skills

　　Ability to work varied shifts

　　The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by the personnel so classified.

　　77211370 Patient Financial Services

　　Working at Bozeman Health is more than just a job--it's a commitment to caring for the communities of Southwest Montana by being their partner in health and wellness, compassionately delivering the best care for each person, every time. In every role, our employees are inspired by their ability to care for our community and our Culture of Excellence guides each employee to be a high performer, engage in transparent and timely communication, demonstrate dynamic learning and teaching, excel through change, express gratitude and experience joy.