Prevea Health
Revenue Integrity Manager - Green Bay, WI
Prevea Health, Green Bay, Wisconsin, United States, 54311
Revenue Integrity Manager
Location: Green Bay, Wisconsin, United States
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.
What you will do
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. 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/or 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). Prepare reports and present findings and recommendations to management.
Oversee and maintain the CDM, identifying opportunities for missed revenue. Including an annual comparison of Prevea's CDM and supply/implant costs to payer contracts. Develop and maintain all retail pricing. 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. Complete analysis of revenue impacts as a result of CMS payment changes.
Perform full range of managerial responsibilities which may include but not be limited to interviewing, hiring, coaching and developing employees; planning, assigning and directing work. Encourage innovation, teamwork, fiscal responsibility, and high‑quality work.
Education Qualifications
Bachelor's Degree Business or Healthcare related; or Associate's degree with 3 years of related work experience in healthcare revenue integrity or revenue cycle. Required
Experience Qualifications
5-7 years Healthcare revenue integrity or revenue cycle experience Required
3-5 years Leadership experience Required
3-5 years Experience with EPIC clinic or hospital billing systems Preferred
Skills and Abilities
Knowledge of Revenue Cycle, Coding, and Charge Capture. Strong understanding of charge capture workflows, CPT/HCPCS, ICD‑10, modifiers, documentation requirements, and payer billing rules.
Regulatory & Compliance Knowledge. In‑depth knowledge of CMS, Medicare/Medicaid, NCCI edits, payer guidelines, pricing regulations, and the ability to apply regulatory updates to internal processes.
Data Analysis & Reporting Skills. Proficiency using EPIC reporting tools and other analytics platforms to extract, analyze, and interpret charge data, denial trends, and financial impact models.
Charge Description Master (CDM) & Pricing Expertise. Ability to maintain and optimize the CDM, evaluate charging accuracy, review payer contracts, and support retail and service line pricing strategies.
Audit & Problem‑Solving Skills. Skilled in conducting charge audits, identifying discrepancies, determining root causes, and recommending corrective actions or workflow enhancements.
Cross‑Functional Collaboration & Communication. Ability to work effectively with coding, billing, clinical, and operational teams, communicating complex coding, billing, and revenue integrity concepts clearly.
Project & Process Improvement Abilities. Ability to lead projects, manage competing priorities, implement corrective action plans, and support continuous improvement initiatives across departments.
Attention to Detail & Documentation Skills. Strong accuracy and documentation abilities to maintain audit records, track trends, ensure compliance evidence, and support training and reporting needs.
Licenses and Certifications
One or more of the following credentials: American Health Information Management Association (AHIMA), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS‑P), Certified Coding Associate (CCA), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), American Academy of Professional Coders (AAPC), National Association of Healthcare Revenue Integrity (NAHRI), or Certification in Healthcare Registry (CHRI). Upon Hire Required
(CHRI) Preferred
EPIC PB Certification Preferred
Physical Demands
Sit - Frequently
Stand - Occasionally
Walk - Occasionally
Drive - Rarely
Climb (Stairs/Ladders) - Rarely
Bend (Neck) - Frequently
Gross Manipulation (Hands/Arms) - Constantly
Squat - Rarely
Kneel/Crawl - Rarely
Twist/Turn (Neck) - Occasionally
Twist/Turn (Waist) - Occasionally
Lift/Carry 0‑10 lbs. - Rarely
Lift/Carry 11‑25 lbs. - Rarely
Lift/Carry 26‑35 lbs. - Rarely
Lift/Carry 36‑50 lbs. - Rarely
Push/Pull up to 10 lbs. - Rarely
Push/Pull 11‑25 lbs. - Rarely
Push/Pull 26‑35 lbs. - Rarely
Push/Pull 36‑50 lbs. - Rarely
Reach (Above shoulder level) - Rarely
Reach (Below shoulder level) - Constantly
Simple Grasping (Hands/Arms) - Constantly
Fine Manipulation (Hands/Arms) - Constantly
Gross Manipulation (Hands/Arms) - Constantly
Working Conditions
Noise - Occasionally
Travel Requirements
5%
Hearing Requirements
Hears Whispers
Hears Whispers 3‑8 feet - Constantly
Vision Requirements
Color Discrimination - Constantly
Near Vision (Correctable to Jaeger 2 or 20/40 binocular) - Constantly
Distance Vision (Correctable to Snellen chart 20/40 binocular) - Constantly
Prevea is an Equal Employment Opportunity/Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility document form upon hire. Prevea participates in E‑verify. To learn more about E‑Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify
#J-18808-Ljbffr
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.
What you will do
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. 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/or 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). Prepare reports and present findings and recommendations to management.
Oversee and maintain the CDM, identifying opportunities for missed revenue. Including an annual comparison of Prevea's CDM and supply/implant costs to payer contracts. Develop and maintain all retail pricing. 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. Complete analysis of revenue impacts as a result of CMS payment changes.
Perform full range of managerial responsibilities which may include but not be limited to interviewing, hiring, coaching and developing employees; planning, assigning and directing work. Encourage innovation, teamwork, fiscal responsibility, and high‑quality work.
Education Qualifications
Bachelor's Degree Business or Healthcare related; or Associate's degree with 3 years of related work experience in healthcare revenue integrity or revenue cycle. Required
Experience Qualifications
5-7 years Healthcare revenue integrity or revenue cycle experience Required
3-5 years Leadership experience Required
3-5 years Experience with EPIC clinic or hospital billing systems Preferred
Skills and Abilities
Knowledge of Revenue Cycle, Coding, and Charge Capture. Strong understanding of charge capture workflows, CPT/HCPCS, ICD‑10, modifiers, documentation requirements, and payer billing rules.
Regulatory & Compliance Knowledge. In‑depth knowledge of CMS, Medicare/Medicaid, NCCI edits, payer guidelines, pricing regulations, and the ability to apply regulatory updates to internal processes.
Data Analysis & Reporting Skills. Proficiency using EPIC reporting tools and other analytics platforms to extract, analyze, and interpret charge data, denial trends, and financial impact models.
Charge Description Master (CDM) & Pricing Expertise. Ability to maintain and optimize the CDM, evaluate charging accuracy, review payer contracts, and support retail and service line pricing strategies.
Audit & Problem‑Solving Skills. Skilled in conducting charge audits, identifying discrepancies, determining root causes, and recommending corrective actions or workflow enhancements.
Cross‑Functional Collaboration & Communication. Ability to work effectively with coding, billing, clinical, and operational teams, communicating complex coding, billing, and revenue integrity concepts clearly.
Project & Process Improvement Abilities. Ability to lead projects, manage competing priorities, implement corrective action plans, and support continuous improvement initiatives across departments.
Attention to Detail & Documentation Skills. Strong accuracy and documentation abilities to maintain audit records, track trends, ensure compliance evidence, and support training and reporting needs.
Licenses and Certifications
One or more of the following credentials: American Health Information Management Association (AHIMA), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS‑P), Certified Coding Associate (CCA), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), American Academy of Professional Coders (AAPC), National Association of Healthcare Revenue Integrity (NAHRI), or Certification in Healthcare Registry (CHRI). Upon Hire Required
(CHRI) Preferred
EPIC PB Certification Preferred
Physical Demands
Sit - Frequently
Stand - Occasionally
Walk - Occasionally
Drive - Rarely
Climb (Stairs/Ladders) - Rarely
Bend (Neck) - Frequently
Gross Manipulation (Hands/Arms) - Constantly
Squat - Rarely
Kneel/Crawl - Rarely
Twist/Turn (Neck) - Occasionally
Twist/Turn (Waist) - Occasionally
Lift/Carry 0‑10 lbs. - Rarely
Lift/Carry 11‑25 lbs. - Rarely
Lift/Carry 26‑35 lbs. - Rarely
Lift/Carry 36‑50 lbs. - Rarely
Push/Pull up to 10 lbs. - Rarely
Push/Pull 11‑25 lbs. - Rarely
Push/Pull 26‑35 lbs. - Rarely
Push/Pull 36‑50 lbs. - Rarely
Reach (Above shoulder level) - Rarely
Reach (Below shoulder level) - Constantly
Simple Grasping (Hands/Arms) - Constantly
Fine Manipulation (Hands/Arms) - Constantly
Gross Manipulation (Hands/Arms) - Constantly
Working Conditions
Noise - Occasionally
Travel Requirements
5%
Hearing Requirements
Hears Whispers
Hears Whispers 3‑8 feet - Constantly
Vision Requirements
Color Discrimination - Constantly
Near Vision (Correctable to Jaeger 2 or 20/40 binocular) - Constantly
Distance Vision (Correctable to Snellen chart 20/40 binocular) - Constantly
Prevea is an Equal Employment Opportunity/Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility document form upon hire. Prevea participates in E‑verify. To learn more about E‑Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify
#J-18808-Ljbffr