Job Information
HealthAlliance Manager, Network Revenue Integrity in Valhalla, New York
Manager, Network Revenue Integrity
Company: NorthEast Provider Solutions Inc.
City/State: Valhalla, NY
Category: Executive/Management
Department: Revenue Integrity
Union: No
Position: Full Time
Hours: 8:30-5pm, M-F
Shift: Day
Req #: 42541
Posted Date: Mar 17, 2025
Hiring Range: $120,220 - $152,177
Apply Now
External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/28798) Internal Applicant link
Job Details:
Job Summary:
Reporting to the Director of Network Revenue Integrity, responsible for oversight of Revenue Integrity in the WMC Health System. The Manager of Revenue Integrity is responsible for development, coordination, implementation of revenue integrity functions.
Responsibilities:
Monitor and assess integrity risks, and ensure that the revenue integrity program is responsive to
those risks. Conducts root-cause analyses with others to identify opportunities for error reduction.
Lead the enhancement of charge captures activities via the integrated revenue cycle applications, and ensure that the CDM accurately reflect services and supplies provided and are consistent with current industry best practices
Researches regulatory requirements relevant to charges, monitors trends, and maintains knowledge of charge-related regulations and standards. Applies knowledge to ensure that charges are accurate, billed correctly, and supportable according to payer and regulatory requirements
Actively participate in committees addressing and/or responsible for revenue integrity activities
Provide weekly and monthly reports to the revenue integrity director regarding the nature, progress, and status of the revenue integrity program, any corrective action being taken, and any recommended changes
Ensure staff members are knowledgeable about revenue assurance needs and reimbursement issues identified through audits, reviews, and aggregate data analysis
Lead regular internal staff meetings
Train, mentor and evaluate staff
Assure staff is meeting or exceeding individual and departmental goals, and implement performance improvement plan.
Perform facility charge related internal audits, and respond to external audits (including Compliance and third-parties)
Oversee outpatient medical denial process, and perform appeals to promote efficiency and revenue optimization.
Provide oversight and direction to Revenue Integrity facility staff related to special projects
Qualifications/Requirements:
Experience:
Prior experience with auditing and internal controls review in healthcare strongly preferred. General knowledge of healthcare revenue cycle including familiarity with reimbursement methodologies, coding, CDM, charge capture, and billing processes. Understanding of compliance issues, their importance and consequences. Demonstrated leadership ability including ability to work in a team, build consensus, problem-solve, influence others outside a direct reporting relationship, and handle conflicts with tact. Ability to work effectively and coordinate the activities of outside consultants. Requires strong technical skills including use of e-mail, spreadsheets, word processing, databases, decision support system, EHR applications, internet searches for research, project management, and reporting.
Education:
Associate Degree in Accounting, Finance or related field, with minimum of 4 years of experience in Healthcare Finance, Billing, and/or Internal Audit functions, required. Bachelor’s degree, preferred.
Licenses / Certifications:
Coding certification highly preferred.
About Us:
NorthEast Provider Solutions Inc.
Benefits:
We offer a comprehensive compensation and benefits package that includes:
Health Insurance
Dental
Vision
Retirement Savings Plan
Flexible Savings Account
Paid Time Off
Holidays
Tuition Reimbursement
Apply Now
External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/28798) Internal Applicant link
Talent Community
Search Jobs
Hiring Events (https://wmchealthjobs.org/job-events-list/)