Manager, Revenue Integrity

Job Number 59379
Posted 3/15/2019
Account Northern Light Health Home Office
Department Revenue Cycle
Location |ME| Northern Light Health Home Office-43 Whiting Hill Rd., ME 04412
Schedule Regular Full-time
Shift Day
Hours 8:00am-4:30pm
Job Details
Job Summary:

The Manager of Revenue Integrity reports directly to the System Director, Revenue Integrity. The Manager of Revenue Integrity is responsible for supervising all work elements of the revenue cycle operations support / financial analysts, revenue cycle specialists, EMHS CDM management, denials management and contract management. Additionally, this position will be responsible for research and education related to revenue integrity best practice processes, report development for measurable improvements of implemented initiatives, ROI/cost study coordination, charge capture analysis, and establishment of standardized thresholds for payment and deduction variances. All duties will be performed at the system level.

It is critical that this position be highly effective in delivering the services described in the Duties and Responsibility and work harmoniously with leaders and staff across EMHS. Effectiveness will be measured in terms of results, commitment to EMHS and customer satisfaction.

This position is a member of the EMHS Revenue Cycle team. Duties may be changed or reassigned by the Chief Revenue Officer as need arises.

Job Functions and Duties:

The Revenue Cycle Manager Revenue Integrity will focus on system-wide business analytics of EMHS Revenue Cycle process, technology, controls and key personnel. This position will also lead in problem solving tools within business operations of the EMHS healthcare system. This role will collaborate with customers to help achieve goals that are efficient, increase revenue, and minimize costs. This position will incorporate the organization's mission, vision and values into all staff development practices and all departmentally directed activities.


1. Supervise, assign and direct tasks as assigned to the members of the Revenue Integrity team.

2. Supervise the establishment of thresholds for deduction variances and build processes to identify exceptions.

3. Research standard business practices for revenue integrity and provide education to hardwire.

4. Meet regularly with involved parties (Patient Accounts, HeIS, Clinical Leadership, etc.)

5. Direct staff in the development of tools to regularly report measurable results (reduced adjustments/costs). Summarize results and report to the System Director Revenue Integrity.

6. Seek appropriate education and training to become knowledgeable in all areas of position and oversee the training and development of staff within Revenue Integrity.

7. Employee tasks to be evaluated and prioritized due to frequency and financial impact:

· Timely filing write offs

· ABNs/Medical Necessity/Non-covered adjustments

· Adjustment code usage reviews

· Payment vs. contract reviews

· Monitor payment percentages for variances

· Review denials management daily work flows

· Review non-audit remittance take backs

· Contractual allowance monitoring

· Cost study coordination / initiative ROI

· Denial management review

8. Oversee work groups and committees as needed

9. Regularly keep the System Director Revenue Integrity informed of any problems or potential problems, status of projects and new items.

10. Keep staff informed of any changes.

11. Require employees to participate in educational programs in order to improve performance.

12. Management of department staff.

13. Participate in EMHS system meetings as required.

14. Assist in the development of the departmental budget, monitor budget variances and keep the Chief Revenue Officer aware of any pertinent variances.

15. Direct and review creation of proforma documents as required.

16. Support member hospital revenue cycle work and review results.


17. Seek and recommend new information technology solutions and or manual changes that support revenue cycle functions.

18. Work collaboratively with departmental personnel to implement systems and process change aimed at improving revenue cycle performance.

Professional Development

19. Attend local, regional and national conferences/seminars to remain current in supporting the needs of Revenue Cycle activities.

20. Review industry publications to maintain knowledge base concerning Revenue Cycle processes.

21. Maintain current knowledge of regulatory developments involving agencies (CMS, AHA, DHS, and Joint Commissions.)

22. Maintain membership with professional associations (HFMA, AAHAM, Etc.)

Note: the duties listed above reflect the majority of the duties of this job and does not, nor is it intended to, reflect all duties that may be required for an incumbent in this job to perform.

Education and Experience:

· Bachelor's degree required. Master's degree in hospital administration or business, is preferred. Eight years progressive, relevant knowledge toward mastery in the field accepted in lieu of Bachelor's degree.

· Eight or more years of progressively responsible experience in revenue cycle analytics.

· Detailed knowledge of Revenue Cycle, Reimbursement and auditing principles.

· Working knowledge of Medical Terminology, Current Procedural Coding (CPT, HCPCS), Diagnostic Coding (ICD-9, ICD-10) and HIPAA ANSI codes.

· Expertise with regulations and accreditation standards, knowledge of specific state and federal requirements and standards as it relates to modern Revenue Cycle systems.

· Working knowledge of Microsoft Office, Excel, Access, Siemens, Monarch, Allscripts, Meditech and other Revenue Cycle systems.

· Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in Revenue Cycle Operations.

Licenses and Certifications:

· Certified Revenue Professional certificate within one year of employment.

Knowledge, Skills, and Abilities:

· Able to proactively make appropriate changes in business analytics to position EMHS for healthcare reform and competition.

· Able to effect collaborative alliances and promote teamwork.

· Ability to ensure a high level of employee, patient, visitor, and external stakeholder satisfaction.

· Effective organizational, planning, controlling, scheduling and project management abilities.

· Effective leadership abilities.

· Ability to effectively influence change.

· Excellent communications skills, both oral and written.

· Flexible and able to react to ever changing priorities.

Travel Requirements:

· 15 – 50% travel may be required.

· Employee must have a valid drivers' license and possess own transportation.

Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.