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Accounting, Actuarial & Finance

Support the Bottom Line — and the Big Picture

Create the financial strategies that affect our patients, medical centers, and future. On this team, you'll provide the strategy recommendations that drive operational and process improvement, as well as face challenging opportunities to influence the future of health care.

Manager, Revenue Integrity

Location: Portland, OR Additional Locations:
Job Number: 807583 Date posted: 06/26/2019
Description:

The Revenue Integrity Manager is responsible for the overall timely and accurate capture of patient service revenue. The position is responsible for oversight of charge capture functions to include the development, implementation and maintenance of charge capture related systems and processes including the charge description master (CDM), pricing and charge structure and prospective/retrospective charge audits. This position is responsible for monitoring current and emerging reimbursement issues, regulations and reporting requirements. This position will oversee and monitor that a consistent, accurate CDM is compliant with regulatory agencies. This position will provide advice and support staff as needed, as well as respond to department charging questions and concerns. This position is responsible for the oversight and remediation of random audits to ensure the accuracy of patient charges and be responsible for researching patient complaints related to charging and pricing, as well as assist with the resolution of patients accounts.


Essential Responsibilities:

  • Charge Capture: Responsible for charge capture for the region including: hospital charging (technical component) and professional charging (physician component). Develop and maintain collaborative working relationships with revenue producing departments, information technology personnel, health information management and coding to include a forum for continuous overall process improvement and feedback. Develop and produces executive level revenue capture dashboard reporting, recommendations and oversight of organization-wide CDM and charge capture strategies and process improvements. Develop a quality program for establishing accuracy and completeness of charging along with applicable reporting to revenue cycle and Permanente. Oversee internal audits related to charge capture departmental issues, revenue leakage and patient complaint audits. Assist staff with the development of project planning and initiatives relative to charge capture to include remediation of audit findings & recommendations, new service lines or business and other enhancement projects.

  • Charge Description Master: Oversees the development, implementation and maintaince of the standard system charge description master (CDM) in accordance with policies and procedures. Monitors compliance initiatives related to CDM data.  Tracks and remediates regulatory compliance investigatory activities and published findings correlated to CDM information. Serve as a resource for compliance information on regulations applicable to healthcare providers. Interacts with leadership, department managers and regional facility staff members regarding CDM compliance and related financial issues.  Meets with department managers, staff, and/or physicians regarding new program and procedure developments, and validation of inactive codes. Critiques informational bulletins, journals, newsletters, and other sources and disseminates pertinent information and instructions to involved staff. Exhibits and maintains an understanding and application of CPT, HCPCS and ICD coding regulations and guidelines. Exhibits the ability to understand or analyze knowledge of billing systems and order entry interfaces with respect to implementation of a standard CDM. Takes initiative to identify system problems and participate in the development of solutions to systems for improvement to billing functions. Acts as Team Leader and/or Project Manager for special projects related to CDM data, reimbursement and regulatory issues.

  • Pricing (CDM and physician fee schedules): Management and accountability for KPNW fee schedule and CDM prices. Research, analyze, and recommend fee structure and derivation methodologies for the Senior Leadership Team to support. Implement prices and maintain pricing when new procedures/supplies/studies/etc. are introduced throughout the year. Develop tools, processes, accountabilities for all pricing decisions. Document the processes and accountabilities.

  • Supervisory and Leadership Responsibility: Develops and oversees strategic vision and on-going enhancement of the Department through planning and execution. Leads the organization through changes to meet new industry, internal or governmental requirements. Communicates and interacts with senior leadership regarding initiatives, outcomes, successes and barriers. Provide leadership, feedback, coaching, counseling, guidance and direction on management of CDM, fee schedules, charge capture and pricing. Assign, distribute, review work assignments ensuring timely and accurate completion. Monitor deadlines. Evaluate work performance through timely performance appraisals and identifying strengths and weaknesses. Assist as a team member in the development, implementation and maintenance of internal controls, SOX controls and policies to maintain sound billing practices. Evaluate needs by providing tools and training, as needed. Provide occasional feedback and regional representation for CDM-related National initiatives.

  • Basic Qualifications:

    Experience

  • Minimum five (5) years of experience with facility and professional services billing, charge capture and CDM experience, (regulatory compliance, billing rules and regulations, maintenance, auditing, internal controls, and pricing).

  • Education

  • Bachelor's degree in health care financial mgmt, business or related field OR four (4) years of experience in a directly related field

  • High School Diploma or General Education Development (GED) required

  • License, Certification, Registration

  • N/A


  • Additional Requirements:

  • Exposure to patient billing and accounts receivable system processes

  • Up to date working knowledge of Medicare billing regulations

  • Up to date working knowledge of medical coding rules and regulations

  • Detailed knowledge of revenue cycle work streams and revenue flow

  • Understanding of Industry specific terminology

  • Revenue cycle process management

  • Significant systems expertise

  • Working knowledge of current Medicare, Medicaid and other regulatory billing guidelines and requirements

  • Comprehensive experience with facility and professional billing requirements


  • Preferred Qualifications:

  • Minimum ten (10) years of experience with facility and professional services billing, charge capture and CDM experience, (regulatory compliance, billing rules and regulations, maintenance, auditing, internal controls, and pricing)

  • Minimum five (5) years of experience as a CDM/Charge Capture Manager in a large hospital system

  • Leadership experience with patient billing and accounts receivable reduction practices

  • Experience with Medicare billing regulations with a strong understanding of compliance requirements

  • Master's degree in health care finance, business or related field

  • Registered coder (CPC or CCS)


  • Professional affiliation with the American Health Information Management Association (AHIMA), the Professional Association of Healthcare Coding Specialists (PAHCS) or AAPC

  • Leadership position in an integrated health system


  • Significant systems expertise with Epic
  • Primary Location: Oregon,Portland,Kaiser Permanente Building 500 NE Multnomah St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Manager with Direct Reports Job Category: Accounting, Finance and Actuarial Services Department: Revenue Cycle Travel: Yes, 5 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    About Accounting, Finance, & Actuarial Careers

    Accounting Careers

    Members of our accounting team support corporate projects and lend insight to areas such as financial reporting, tax planning and preparation, and audit management. This team also includes our audit professionals, who partner with financial and operational groups across the organization to analyze budgets and streamline procedures.

    Finance Careers

    Supporting critical business functions such as financial services, national Medicare finance, strategic planning, auditing, and corporate finance, our finance professionals develop the strategies that enable us to meet our financial goals.

    Actuarial Careers

    Applying probability and statistics to the practical problems of insurance, our actuarial team performs a variety of duties, including calculating the cost of premiums and policy values, preparing statistical studies, and forecasting financial results.

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