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Revenue Integrity Manager- AdventHealth Maitland

Location Address:  900 WINDERLEY PL, Maitland, 32751

Top Reasons to work at AdventHealth Maitland

• The Maitland Office Plaza houses our highly skilled teams that support our hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union and Human Resources.
• The Trickle Building, a two-story office structure, creates an atmosphere of health and healing, with a healthy-style café and quaint chapel.
• The main lobby is filled with lush greenery and a light trickle of water, creating a holistic environment.
• We offer great benefits with immediate Health Insurance coverage
• Career growth and advancement potential

 Work Hours/Shift:      Full Time / Day (Hybrid Schedule)

You Will Be Responsible For:  

• Operational management of charge auditing, denials, and clinical liaison teams through effective staffing plans and work assignments. Drives operational workflow with accountability for meeting established quality and productivity goals while seeking ways to improve the efficiency and accuracy of charge capture.  Responsible for providing team members with the tools and training needed to effectively meet these goals. Assists in evaluating monthly budget and staffing needs by scheduling staff levels to meet volumes, proactively flexing staffing to ensure goals are maintained.
• Oversees the Clinical Liaison team and assists by bridging the gap between the clinical, finance, and revenue cycle departments. Continually evaluates clinical department charge capture processes, department functions, and revenue flows to ensure appropriate compliance with billing and regulatory guidelines and communicates effectively with department leaders and staff. Works proactively, serving as a centralized resource to Revenue Cycle, Clinical, MIS, Managed Care, Finance, Accounting, and other related departments as it relates to revenue integrity. Assists with charge establishment for new services and departments.
• Accountable for the denials’ process, ensuring appeals are completed timely while seeking proactive approaches to avoid denials.  Works with Revenue Integrity leaders, Clinical Liaisons, and charge auditing team members to proactively identify opportunities to avoid denials.  Understands various clinical information systems and reviews both inpatient and outpatient accounts to reduce denial rate and write off amount.  Proactively works with revenue cycle department leaders to provide education as it pertains to changes in medical necessity, in accordance with local/national guidelines. 
• Maintains extensive knowledge of regulatory and billing guidelines, standards of clinical practice, and working knowledge of revenue cycle processes while proactively researching new and changing regulations to ensure system operations are aligned with requirements.  Implements changes as needed to ensure compliance is adhered to and educational gaps with employee teams and impacted departments are filled. 
• Provides continual education to Revenue Cycle employees, leaders, and related departments on principles of Revenue Integrity to include compliance, denial avoidance, and Chargemaster practices.  Communicates effectively and collaborates with other departments to implement regulatory standards that assist in revenue attainment while accurately complying with billing guidelines.
• Develops and manages revenue process improvement strategies in support of clinical departments, implementation of information systems, and process initiatives.  Responsible for maintaining system edits to ensure they achieve compliance, payment optimization, and process efficiency across Revenue Cycle.  Responsible for ensuring the Chargemaster is properly maintained and updated to ensure all charging and coding regulations are followed and compliance is achieved. Responsible for the implementation of the annual changes to Hospital Outpatient Prospective System and assists with annual pricing updates.