Manager in Oceanport, New Jersey at RWJBarnabas Health

Job Title: Manager

Location: System Business Office

Department Name: Revenue Integrity

Req #: 0000246221

Status: Salaried

Shift: Day

Pay Range: $105,000.00 - $145,000.00 per year

Pay Transparency:

The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

Job Overview:

The Manager of the Revenue Integrity department is responsible for performing the daily tasks of the department in addition to oversight of these specific tasks, not limited to: Facility Structure Lead, Charge Master Maintenance, Maintain Department Audit Plan, Continuous Process Improvement Support, Lead education initiatives, Development of Team Tools/Processes/Job Aides, and Maintain Logs for Build Decisions.

Qualifications:

Required:

• Bachelors Degree or equivalent experience in Business, Finance, Nursing, or Health Information Management related field.
• At least five years minimum recent experience in healthcare finance, revenue cycle management, CDM maintenance or related field.
• Must have revenue code, CPT and HCPC coding knowledge.
• General understanding of multiple reimbursement systems including IPPS, OPPS, and Fee Schedule.
• Knowledge of accurate sources for updating all applicable code sets (CPT/HCPCS, ICD-10, etc,) inclusive of associated edits such as NCCI, Well-developed research skills.
• Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including administrative and management staff.
• Possess effective oral and written skills.
• Ability to interpret and implement regulatory standards.
• Excellent organizational and project management skills.
• Possess effective time management skills to permit handling of multiple projects simultaneously.
• Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook, Excel and Access.

Preferred:

• Epic experience preferred
• Experience in an Academic setting preferred.
• Preferred: Registered Nurse (RN), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) credentials preferred.
• Other allied health certification and/or specialized Degree considered.

Scheduling Requirements:

• Full-Time, Salaried position– 37.5 hours a week
• Travel to Oceanport, NJ or other business sites as needed

Essential Functions:

• Credentials are expected to be maintained in accordance with licensing body/accreditation body.

• Maintains positive relationships with all customers, employee, physician, patient, visitor, and guests.
• Utilizes a variety of feedback to improve processes and services to meet and exceed customer needs.
• Uses sound employee relations practices and maintains high levels of visibility and accessibility.
• Follows through on all customer requests and inquiries in a timely fashion.
• Utilizes principles of CQI in all work situations.
• Seeks feedback and recommendations from others to improve the quality, processes and services.
• Contributes to improving quality services and productivity (takes the initiative to continually evaluate ones work, report problems, suggest solutions and try new ideas).
• Effectively allocates and schedules resources.
• Able to project and appropriately staff the unit/department to effectively function to demand.
• Utilizes resources, both labor and non-labor to maximize efficiency and quality.
• Adheres to budgetary guidelines and targets-proactively manages budget variances and causes.
• Determines priorities and organizes work and time to meet them.
• Follows sound employee retention techniques; effective selection and interviewing, recognition, fair and timely discipline, and ongoing performance feedback.
• Interacts constructively, tactfully and diplomatically with others and resolves conflicts effectively.
• Demonstrates cultural competency and ability to maintain a diverse workforce.
• Completes tasks and assignments in a timely, accurate and efficient manner.
• Remains positive and focused despite obstacles and setbacks.
• Demonstrates a sense of urgency in completing assignments.
• Organizes multiple assignments and/or projects simultaneously to accomplish goals.
• Oversee department build to ensure new department follows appropriate structure.
• Includes but not limited to determination of new cost center assignment, off campus designation, provider-based designation.
• Ensure team is completing in accordance with the New Department Check List.
• Responsible for maintaining accuracy of CDM structure to ensure the RWJ Barnabas CDM standard is maintained.
• Establish annual and quew process to assess CDM against any CMS or AMA regulatory updates.
• Use analytic tools to analysis CDM file to determine line items requiring review and updates.
• Evaluate any third-party payer variance requests and approve associated over-rides.
• Direct Revenue Integrity Analysts and Specialists to ensure appropriate procedures are in place to safe guard CDM updates are completed accurately and timely.
• Provide direction to Revenue Integrity Specialist in terms of appropriate pricing, revenue code assignment and descriptions Oversee team activities for auditing of system updates and completion of charge capture tools such as preference lists, flow sheets, charge navigator screens, etc.
• Lead annual review of cost variances to update chargeability and Epic cost field.
• Coordinate with Supply Chain Management to run supply master with current contract cost.
• Evaluate chargeability status based on CMS guidelines and RWJ Barnabas Health cost price threshold.
• Oversight with non-Epic software implementations.
• Support IT initiatives to assess if the technology warrants a chargeable service.
• Include guidance on applicable charges in scope and appropriate charge point, and supporting clinical documentation/report.
• Participants in charge testing to ensure compliant output.
• Makes recommendations for monitoring reports to ensure accurate charge capture.
• Oversee post implementation audits to ensure changes in process and/or technology result in desired outcomes.
• Lead and/or oversee department audits on processes that have changed.
• Prepare reports on findings to confirm accuracy and or lead appropriate mitigation plan. Set annual audit plan for the department for service line audits.
• Assist team members for audit approach, and implementing necessary changes.
• Lead team in utilizing proper tools to audit, includes but not limited to Encounter Summary Report, Posted Charge Summary Report, Hospital Transaction Report, and Slicer Dicer to evaluate appropriateness of quantities, modifiers, CPT/Codes.
• Assist in the development, generation, manipulation, and presentation of information critical to the ongoing measurement and operation of various Revenue Integrity key performance indicators including but not limited to HB Overview Dashboards, Revenue Integrity Dashboards, Work Queue metrics, and Slicer Dicer Reports.
• Reviews indicators and assesses increase in volume/dollars impacting Candidate for Billing (CFB) metrics.
• Evaluates charge reconciliation tools available and makes recommendations for reports or practices as needed.
• Evaluates Epic Work Queues (Account, Charge, Claim, and Charge Router) and Procedure/Surgical Log metrics to identify trending issues.
• Escalates opportunity for clinical application enhancements and HB workflow enhancements.
• Evaluates Epic enhancements and upgrades to ensure charging compliance.
• Escalates workflow/charging issues to Revenue Integrity Assistant Vice President, IT Teams, and/or Site Financial Officer as needed
• Maintain currency in regulatory issues that affect billing and compliance.
• Lead plan on necessary education to team and impacted staff such as Billing, HIM, Clinical IT Teams, etc.
• Serve as a lead resource to department heads and designated staff regarding potential changes related to coding and billing regulations.
• Review LCD and NCD updates and lead communications important changes to appropriate department heads
• National Coverage Determination (NCD)/Local Coverage Determination Communication (LCD)
• Lead team process to review LCD and NCD updates and communicate important changes to appropriate department heads.
• Oversee plan to monitor for denial trends and educational opportunities to departments.
• Develop team training materials, job aids, and policy/procedures to ensure consistent practices amongst the team
• Ensure documentation is maintained for Epic build decisions which include but not limited to department contact lists, charge points for each service line, Epic Charge Router Rules, and Revenue Guardian Rules.
• Review and approve Epic Charge Router Rules that impact charges to ensure compliance with CMS billing guidelines and coding guidelines.
• Maintain log of all Charge Router Rules approved. Review log annually to determine necessary changes.
• Recommend and approve additions or deactivation of Revenue Guardian Rules to ensure that potential missing charge anomalies identified are assigned to and addressed by the appropriate departments and used to identify trends and patterns associated with missed charges.
• Review log annually to determine necessary changes impacted by coding updates.
• Maintain each facility list of contacts, charge point by service line to include cost center detail, off campus designation, and other pertinent information to validate charging compliance and follow-up.
• Coordinate with Revenue Integrity Specialists to assist in validating and updating information.
• Perform Special Projects for the Assistant Vice President of Revenue Integrity and other duties as assigned

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Benefits and Perks:

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees’ physical, emotional, social, and financial health.

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey—whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employer