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Role Description

The revenue manager is responsible for the daily operations of the Reimbursement Charge Master staff. Daily operations include communication to facility leadership on revenue analysis related to posted charges of the day prior and special projects related to either revenue or reimbursement.

• Proper management of the charge entry and revenue flow is critical to the successful coding and billing of claims to third party payors in the revenue cycle.
• Incorporating mandatory CPT/HCPCS codes to specific charges and setting programming triggers in the billing system to update hospital claims relative to the primary insurance payor.
• Maintaining the fee schedules which drive hospital pricing on to patient claims.
• Design, build, maintenance, quality assurance, testing and implementation for all charges and prices loaded into EPIC Hospital Billing.
• Designated by EPIC as the Revenue Integrity Lead on the vendor’s Integrated Good Maintenance organizational support chart.
• Responsible for the scope and implementation of appropriate charging workflows for each hospital service line based upon clinical applications.
• Meetings with all levels of hospital and corporate leadership to represent the team, department or Director of Reimbursement on matters related to gross revenue generation and net reimbursement from third party payors.
• Annual projects include the successful implementation of the annual rate increase across 440 hospital departments for Premier and the annual code changes published by both the American Medical Association (AMA) and Medicare (CMS).
• Collaboration with Premier Health Information Technology to ensure that both master files for charge creation and charging workflows continue to perform to pre-upgrade specifications.
• Provide technical guidance to IT teams and charge master staff on the build, testing and final validations related to system changes related to revenue generation.

This is a 100% remote work-from-home position

Qualifications

• Bachelor’s degree in finance or related field is required.
• Master’s Degree is preferred.

Requirements

• Epic Hospital Billing or Epic Charge Master is preferred.
• Coding certification in at least one of the following is also preferred: CPC, CPC-P, RHIA, RHIT, and/or certification in auditing and/or Healthcare compliance.
• Designation of proficiency in Hospital Billing and Charge Master is preferred.
• Minimum of 5 - 7 years of job related experience.
• Minimum of five to seven years in hospital finance and or healthcare reimbursement.
• 3-5 years of prior management experience preferred.
• A strong understanding of healthcare reimbursement required.
• Knowledge of CPTs, APCs, DRGs, and HCPCS code is required.
• Current knowledge of hospital billing practices is required.
• Current knowledge of Medicare and Medicaid regulations is required.
• Two years of project management experience required.
• Experience in working with upper management, physicians, and information systems is required.
• EPIC file maintenance experience required.
• Report writing experience required.
• Understanding of Managed Care contracts and language.