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Manager, DMG Revenue Integrity

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Job Details
Job Order Number
JC111307365
Company Name
Decatur Memorial Hospital
Physical Address

Decatur, IL 62523
Job Description

Manager, DMG Revenue Integrity

Department:

82060 Revenue Integrity

Status:

Full Time 40 HRS

Shift:

Days

Work Hours:

8-4:30

Job Details:

+ Summary Decatur Medical Group (“DMG”) consists of physician and non-physician practitioners providing professional services to Decatur Memorial Hospital patients.The Manager of DMG Revenue Integrity is responsible for coordinating the day-to-day support functional and financial activities taking place at DMG’s multi-specialty group practices. The Manager will be the primary point of contact for revenue cycle outreach initiatives. The Manager provides the necessary functions to assist revenue cycle to help improve process, documentation and the financial success of the DMG. These activities will be performed under the direction of the Director of Revenue Integrity. Essential Functions and Job Duties · Act as a resource to DMG, clinical staff and physicians in relation revenue cycle as a whole. · Understand the clinical aspect of the practice as well as the financial side to improvethe revenue stream from beginning to end. · Able to collaborate extensively with physicians, nurses, other caregivers, and revenue cycle staff to improve quality and completeness of documentation of care provided. · Develop tool (job aides, templates, etc.) that will aid providers, practice managementand office staff the ability to capture all identified revenue in a compliant manner. · Ongoing responsibility to identify opportunities to help address preventable revenue loss. · Assist in the collection and analysis of risk adjustment data in-order to identify documentation, coding trends and revenue opportunities · Independently review and analyze denial information from third party payers to understand reasons for denials. Coordinate with practice management and revenue cycle as needed to address operational issues contributing to denials. · Assist the Director of Revenue Integrity to evaluate CPT / HCPCS and ICD-10-CM code additions, deletions and revisions and how they may affect the Ambulatory charge master. · Conduct educational training classes for DMG staff with topics related to revenue cycle. · Understand the life of a claim and the steps involved including registration, prior authorization, outpatient clinical documentation improvement, HIM, revenue integrity and business office and their roles in an attempt to decrease denialsfor the practices. · Assess and assist with implementation of system workflows, implementation of system-wide processes and assessments of revenue cycle performance. · Seeks to establish and strengthen interdepartmental relationships and efficiencies · Assists physicians and other clinical staff regarding the significance of appropriate documentation to support clinical care, quality, and coding · Identifies factors influencing the complexity of the patient’s diagnosis and treatment plan; works collaboratively with physicians to improve the qualityof outpatient clinical record documentation for outpatient clinical documentation improvement · Complete administrative activities such as time reporting, productivity reportingand expense reporting as necessary and in accordance with established policiesand deadlines. · Communicates in a positive and professional manner with visitors, physicians, and hospital staff. · Maintains an optimal working relationship with peers, other hospital departments, and physicians. Perform other job-related duties as required. Education and/or Other Requirements Registered Nurse (RN), CCDS, CDIP, RHIA, RHIT, CPC, CRC, or CCS; or combination thereof preferred 3 or more years’ experience either in the clinical field (RN), CDI field, (CCDS, CDIP) or coding (RHIA, RHIT, CPC, CRC, CCS)

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