Cone Health

Not-for-profit healthcare network delivering hospital care

Manager Revenue Integrity

Accounts Payable/ReceivableConfirmed live in the last 24 hours

Full-timeGreensboro, NC, USANo salary listed

About the Job

Requirements

A bachelor's degree is required.
Six years of experience in Revenue Cycle is required.

Responsibilities

Set departmental productivity and quality objectives, and develop and manage the departmental audit system to ensure team member compliance with standards.
Offer training and coaching to enhance leadership and team performance.
Assist in creating departmental strategic planning.
Serve as a key revenue integrity contact addressing denials, underpayments, refunds, and reimbursement.
Collaborate with physicians, payers, service line leaders, team members, and other internal and external stakeholders to meet organizational financial objectives and enhance revenue capture and reimbursement.
Serve as a key liaison with third-party payers to resolve complex, escalated issues.
Analyze revenue cycle performance data to enhance reimbursement and revenue capture.
Communicate data and insights to stakeholders to drive action and process improvements.
Design and develop data reporting systems for timely distribution of information.
Monitor and interpret government regulations impacting revenue cycle operations, inform stakeholders of changes, and ensure organizational compliance.
Lead revenue cycle compliance changes.
Monitor and inform stakeholders of managed care payer policy changes and ensure organizational readiness.
Lead and participate in cross-functional organizational committees supporting financial goals, reimbursement, and compliance and regulatory activities.
Oversee revenue integrity enrollment, credentialing, and revenue cycle auditing functions.
Serve as a subject matter expert on enrollment, credentialing, and revenue cycle compliance affecting reimbursement by governmental and managed care payers.
Oversee planning, direction, and control of clinical denial management and audit activities involving government and managed care payers.
Collaborate with internal and external stakeholders to develop processes and systems that minimize denials and maximize reimbursement.
Communicate with a broad audience to address denial issues and implement process improvements.
Oversee the revenue integrity payment variance and refund function.
Collaborate with managed care contracting to resolve complex issues and ensure billing-system payment expectations are accurate.
Partner with cross-functional leaders to resolve issues affecting reimbursement.
Serve as a subject matter expert on reimbursement, payment variance, and refunds, and guide resolution of complex issues.
Design and facilitate training for a diverse audience to support organizational financial objectives.
Oversee the revenue integrity education program, including delivery and content design.

Desired Qualifications

A master's degree is preferred.
HFMA CHFP, FHFMACoding CCS, RHIA, RHITEPIC certification in Revenue Cycle Modules is preferred.

Professional Non-Clinical

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!

Our people make all the difference in our success.

The Revenue Integrity Manager is responsible for the oversight and management of the department's daily activities, ensuring departmental goals are achieved through the implementation of quality control, productivity measures, and auditing processes. This position provides leadership to team members and managers. This position serves as a key stakeholder in the organization's reimbursement and revenue activities, conducting analyses of revenue cycle data to support the financial objectives of the health system. The manager also interprets governmental regulations, leading the development and implementation of process enhancements to comply with these standards.

Essential Job Function:

Sets departmental productivity and quality objectives, develops and manages the departmental audit system to ensure team member compliance with standards.
Offers training and coaching to enhance leadership and team performance.
The position also assists in creating departmental strategic planning.
Serves as key revenue integrity contact addressing issues such as denials, underpayments, refunds, and reimbursement.
Collaborates with a diverse internal and external audience including physicians, payers, service line leaders, and team members, to ensure organizational financial objectives are met and enhance revenue capture and reimbursement.
Serves as key liaison with third party payers to resolve complex, escalated issues.
Analyzes a diverse set of data related to revenue cycle performance to enhance reimbursement and revenue capture.
Communicates data and insights to stakeholders to drive action and process improvements.
Additionally, the position entails designing and developing data reporting systems for timely distribution of information.
Monitors and interprets government regulations impacting revenue cycle operations, ensuring stakeholders are kept informed of any changes, and organizational compliance.
Serves as a key leader for revenue cycle compliance changes.
Additionally, monitors and informs stakeholders of changes and updates to managed care payer policies and ensures organizational readiness.
Leads and participates in cross functional organizational committees to support organizational financial goals, reimbursement, and compliance/regulatory activities.
This role oversees the operations of the revenue integrity enrollment, credentialing, and revenue cycle auditing functions.
Serves as a subject matter expert related to enrollment, credentialing, and revenue cycle compliance impacting reimbursement by both governmental and managed care payers.
Oversees the planning, direction, and control of clinical denial management and audit activities from government and managed care payers.
Collaborates with both external and internal stakeholders to develop processes and systems that minimize denials and maximize reimbursement.
Effectively communicates with a broad audience to address denial issues and implement process improvements.
Oversight of the revenue integrity payment variance and refund function.
Works in collaboration with managed care contracting to resolve complex issues and ensure the accuracy of payment expectations in the billing system.
Partners with cross functional leaders to resolve issues impacting reimbursement.
Serves as a a secret matter expert related to reimbursement, payment variance, and refunds and guides the resolution of complex issues.
Designs and facilitates training for a diverse audience to support organizational financial objectives.
Additionally, oversees the revenue integrity education program to include delivery and content design.

Education:

Required: Bachelor's Degree
Preferred: Master's Degree

Experience:

Required: 6 years of experience in Revenue Cycle.

Licensure/Certification/Listing:

Preferred: HFMA CHFP or FHFMACoding CCS, RHIA, RHITEPIC certification in Revenue Cycle Modules.

Work Shift :

Days/No Weekends (United States of America)

On Call Required

FTE:

Job Type:

Full Time (40 Hours/Week)

About the Company

Cone Health

Not-for-profit healthcare network delivering hospital care

Cone Health is a not-for-profit healthcare network that serves communities in Alamance, Forsyth, Guilford, Randolph, Rockingham, and surrounding counties by operating hospitals, primary and specialty care clinics, and centers for heart and vascular care, cancer treatment, women’s and children’s health, and advanced imaging. Its services are delivered through a system of hospitals, clinics, and the Cone Health Medical Group and Triad HealthCare Network, with revenue coming from patient services, insurance reimbursements, and government programs. The network differentiates itself by emphasizing community care and serving underserved populations, supported by a large staff, physician partners, and volunteers, and it holds recognized workplace culture awards. The goal is to provide high-quality, accessible healthcare and improve health outcomes across its diverse service areas.

Company size: 5,001-10,000
Company stage: Seed
Total funding: $100K
Headquarters: Greensboro, NC
Founded: 1953

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