Revenue Integrity Program Manager
84748BR
Shared Service Center
Status
Full-Time
Standard Hours per Week
40
Job Category
Accounting/Finance,
Regular, Temporary, Per Diem
Regular
Pay Range
$99153.60-$158631.20 Annual
Office/Site Location
Westwood
Remote Eligibility
Part Remote/Hybrid
Job Posting Description
At Boston Children’s Hospital, the quality of our care – and our inclusive hospital working environment – lies in the diversity of our people. With patients from local communities and 160 countries around the world, we’re committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices are heard and ideas are shared. Join us, and discover how your unique contributions can change lives. Yours included.
| Key Responsibilities: 1. Helps ensure adequate training and education occurs to both providers and foundations staff regarding accurate charge capture and documentation requirements. 2. Oversees Charge Reconciliation and Charge Capture processes and training materials. Develops, documents, and maintains effective charging policy, procedures and training materials for the PO and Shared Service Center. 3. Works directly with foundations and other key staff of revenue producing departments to identify billable services and establish the charge process. 4. Participates in research of billing and coding requirements when new procedures and/or supplies are introduced. If appropriate to bill for new services, ensures related systems are set up correctly, tested, and monitors initial charging of services for proper billing as well as following claims for initial reimbursement. 5. Liaises with key stakeholders including Foundations, Finance, Compliance, HIM, Coding, CDI, Clinical Departments, Information Technology, as well as others. 6. Facilitates the dissemination of information regarding government and third-party payer regulations and requirements to foundations, providers, management and staff, as applicable. 7. Oversees communication of coding and billing updates published in third-party payer newsletters/bulletins and provider manuals to all stakeholders as appropriate. 8. Works collaboratively with Professional Coding, Foundations and Compliance (when indicated) with performing appropriate reviews, investigating trends and patterns, and providing education regarding documentation, charge capture, charge reconciliation, billing/coding guidelines and denials. Ensures reviews are conducted on an annual basis and/or as otherwise identified, in all areas treating patients to ensure all professional billable charges are captured and coded completely and accurately, and documentation reflects same. 9. Maintains a revenue optimization database, communicates and coordinates resolution of opportunities. Presents and communicates findings, trends, mitigation efforts and recommendations to established Committees and key stakeholders. 10. Assists and makes recommendations for third-party payer contract language related to clinical coding standards and requirements. 11. Develops and monitors metrics to ensure functions of the Revenue Integrity team are performed efficiently as well as with a high degree of accuracy and customer service. 12. Demonstrates support for the mission, values and goals of the organization. Knowledge of Healthcare Revenue Cycle: Understanding of billing, coding, collections and License preferred: Clinical license such as Registered Nurse (RN), Registered Respiratory Therapist (RT), Medical Technologist (MT), Registered Pharmacist (RPh) Certification preferred: Coding certification such as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or AHIMA Certified Coding Specialist (CCS). Project Management Professional (PMP). Minimum Qualifications Education: Required Bachelor’s degree or equivalent experience Experience: 8-10+ years of progressively responsible healthcare revenue cycle experience, with a strong |
The posted pay range is Boston Children’s reasonable and good-faith expectation for this pay at the time of posting.
Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.
Boston Children’s Hospital is an Equal Opportunity Employer. We do not discriminate on the basis of race, religion, color, gender, sexual orientation, pregnancy, national origin, ancestry, ethnicity, age, disability, military or veteran status or any other classification protected by law in hiring, promotion, compensation and other terms and conditions of employment. Boston Children’s Hospital collects and maintains information regarding gender, race, and ethnicity for equal opportunity compliance purposes. Boston Children’s Hospital also is subject to various government recordkeeping and reporting requirements for the administration of civil rights laws and regulations.
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