Revenue Integrity Manager

MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE:
1. Four year undergraduate degree from an accredited college or university or equivalent experience.

PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE:
1. Registered Nurse License
EXPERIENCE:
1. Three years hospital billing audit - compliance experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Maintains financial impact data.
2. Participates in PI Teams and projects as required.
3. Serves as member of the Corporate Compliance Committee. Facilitates Revenue Integrity Communication lines.
4. Works billing edits daily coordinating proper reporting of modifiers - CPT(Wellington Report).
5. Identifies coding related issues and potential process - accuracy improvements - and communicates findings. Identifies late charge trending problem areas and works with ancillary departments to improve.
6. Works closely with PFS Director and Billing Manager to manage revenue capture issues. Performs concurrent audits to identify opportunity to improve.
7. Performs and manages external defense audits. Performs patient request audits.
8. Performs monthly and quarterly assigned compliance audits.
9. Provides charge process education and identifies improvement opportunities. Works closely with ancillary departments and charge master vendor.
10. Trends and reports audit findings to impacted parties.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SKILLS & ABILITIES:
1. Knowledge of Medicare billing - charging - coding regulations.

Additional Job Description:

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WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.