JOB SUMMARY

This position is responsible for day-to-day operations of the Charge Integrity department.  The Charge Integrity Manager performs duties of high complexity, judgment, and scope under the direction of the Charge Integrity Director. The Charge Integrity Manager is responsible for the staff that reviews and makes necessary edits regarding hospital and professional charges, ensuring that services are compliant with federal, state, private payer, and other applicable legal and regulatory requirements. He/she is responsible for the planning and implementation of functional area-based system applications, developing work teams, delegating tasks, coordinating unit or departmental projects, workflow, training, and development of staff.
 

Hybrid position:  

Will be onsite for department meetings and \"go live\" events. 

Must live in the Baylor Scott & White service area (DFW, Central Texas, College Station, Greater Austin Region).   

 

 

ESSENTIAL FUNCTIONS OF THE ROLE

Responsible for the day to day operations of the department and has direct oversight and management responsibility for the patient accounting system charge review, charge DNB, and charge claim edit. Oversees utilization of edit outputs from patient accounting system and other revenue cycle systems to provide information and training to charge capture teams and operational directors/managers.

Manages charge and edit workflows that fall within the scope of service. Serves as an internal resource to clinical departments, revenue cycle operations, and other departments as needed to resolve charging errors.

Establishes and maintain effective lines of communication on charging issues with both internal and external entities. Maintain current knowledge of all charge entry systems and related processes in the clinic and hospital patient accounting systems.

Maintain an in-depth knowledge of how orders and charges are entered and how various systems flow for proper generation of charges for billing. 

Develop proper edit management based on trending within the patient accounting system.

Lead efforts to update charge edits to validate the accuracy of information and compliance with payer requirements. Exercise independent judgment in best practice for charging edit initiatives.

Develop, coordinate, and provide educational in-services to revenue cycle staff, ancillary staff, and clinicians related to charging, documentation, coding and other billing requirements. Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership; monitor effectiveness of departmental corrective action plans.

Collaborate with revenue cycle leadership to identify and resolve revenue and compliance issues as needed. Interact with ancillary departments to obtain additional information needed to properly bill accounts based on documentation in the medical record.

Establish standards of work and department protocols. Manage payroll.

Monitor productivity and work quality and manage department staffing requirements. Manages department expenses as appropriate.

Performs other position appropriate duties as required in a competent, professional and courteous manner.

KEY SUCCESS FACTORS

Technical knowledge of correct coding principles of CPT/HCPCS and modifier selection, as well as UB04 revenue codes.

Skills need to include knowledge of hospital/clinic operations, hospital/clinic department charge capture, revenue cycle services and CMS regulations.

Working knowledge of hospital systems utilized in revenue cycle functions including registration, charge entry, order entry, current coding systems, billing and medical terminology.

Ability to communicate effectively, both in writing and orally; courtesy; initiative; resourcefulness and establish and maintain working relationships.

Proficient with MS Office applications / proficient typing (35 wpm minimum)/keyboarding skills and ability to multi-task.

Must have at least 3 years of hospital experience, with at least 2 being in a position of hospital or clinic leadership (lead or above).

Must have the ability to communicate effectively with Senior Leadership as well as clinical Directors, Managers, staff, consultants and third party payers.

Registration regulatory requirements in the hospital and clinic environments.


BENEFITS

Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level

 

QUALIFICATIONS

- EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification

- EXPERIENCE - 3 Years of Experience