Prevea Health
Revenue Integrity Manager
Prevea Health – Green Bay, Wisconsin
Job Summary The Revenue Integrity Manager will lead the development of the revenue integrity function and is responsible for the oversight and management of the revenue integrity team. This position is accountable for optimizing revenue by ensuring accurate, compliant, and efficient charge capture and billing practice. The Revenue Integrity Manager will improve the performance of revenue cycle processes including developing best practices, coordinating issue resolution, establishing proactive lost revenue prevention measures, and monitoring compliance. The ideal candidate has a strong understanding of EPIC systems, coding standards, and billing regulations across both physician and facility revenue streams.
Responsibilities
Utilize data analytics and process improvement techniques to identify potential revenue leakage and support accurate charge capture.
Use EPIC reporting tools to extract and analyze charge data, perform extensive data mining, develop reports, review trends, and recommend enhancements to resolve lost revenue.
Manage a team of chart reviewers and design and implement a chart review program to ensure completeness of records, appropriateness of billing, and compliance with regulatory and payer requirements.
Identify coding and documentation discrepancies to provide recommendations.
Monitor for positive or negative trends in coding, charge capture and editing processes.
Analyze denial trends related to charge capture and billing.
Collaborate with coding, billing, and clinical teams to identify root causes and implement corrective actions.
Maintain documentation of audit findings, trends, and resolutions to support compliance and training efforts.
Measure key performance indicators (KPIs) and prepare reports and present findings and recommendations to management.
Oversee and maintain the CDM, identifying opportunities for missed revenue.
Develop and maintain all retail pricing and participate in service line pricing reviews.
Research and stay current on CMS, federal and state regulations, payor guidelines, ensuring compliance and alignment with charge, coding and charge edits.
Qualifications • 3+ years of experience in revenue integrity or related revenue cycle management roles. • Demonstrated proficiency with EPIC systems and reporting tools. • Strong understanding of medical coding standards, billing regulations, and payer requirements. • Proven experience in data analytics, process improvement, and leading teams. • Excellent communication and presentation skills.
Seniority Level
Mid-Senior level
Employment Type
Full-time
Job Function
Accounting/Auditing and Finance
Hospitals and Health Care
Prevea is an Equal Employment Opportunity/Affirmative Action employer.
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Job Summary The Revenue Integrity Manager will lead the development of the revenue integrity function and is responsible for the oversight and management of the revenue integrity team. This position is accountable for optimizing revenue by ensuring accurate, compliant, and efficient charge capture and billing practice. The Revenue Integrity Manager will improve the performance of revenue cycle processes including developing best practices, coordinating issue resolution, establishing proactive lost revenue prevention measures, and monitoring compliance. The ideal candidate has a strong understanding of EPIC systems, coding standards, and billing regulations across both physician and facility revenue streams.
Responsibilities
Utilize data analytics and process improvement techniques to identify potential revenue leakage and support accurate charge capture.
Use EPIC reporting tools to extract and analyze charge data, perform extensive data mining, develop reports, review trends, and recommend enhancements to resolve lost revenue.
Manage a team of chart reviewers and design and implement a chart review program to ensure completeness of records, appropriateness of billing, and compliance with regulatory and payer requirements.
Identify coding and documentation discrepancies to provide recommendations.
Monitor for positive or negative trends in coding, charge capture and editing processes.
Analyze denial trends related to charge capture and billing.
Collaborate with coding, billing, and clinical teams to identify root causes and implement corrective actions.
Maintain documentation of audit findings, trends, and resolutions to support compliance and training efforts.
Measure key performance indicators (KPIs) and prepare reports and present findings and recommendations to management.
Oversee and maintain the CDM, identifying opportunities for missed revenue.
Develop and maintain all retail pricing and participate in service line pricing reviews.
Research and stay current on CMS, federal and state regulations, payor guidelines, ensuring compliance and alignment with charge, coding and charge edits.
Qualifications • 3+ years of experience in revenue integrity or related revenue cycle management roles. • Demonstrated proficiency with EPIC systems and reporting tools. • Strong understanding of medical coding standards, billing regulations, and payer requirements. • Proven experience in data analytics, process improvement, and leading teams. • Excellent communication and presentation skills.
Seniority Level
Mid-Senior level
Employment Type
Full-time
Job Function
Accounting/Auditing and Finance
Hospitals and Health Care
Prevea is an Equal Employment Opportunity/Affirmative Action employer.
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