The Revenue Integrity Team Lead is responsible for management, coordination, and supervision of all Shriners Hospitals for Children (SHC) clinical audits conducted by Revenue Integrity Department Auditors. This position will handle the day-to-day operations of the Team including but not limited to assisting in the development, training, and assignment of work/projects to the team members, and providing oversight for SHC hospitals, clinics, and ancillary departments to ensure appropriate billable charges are captured and supported by documentation within the patient medical record in compliance with all federal, state, managed care, and payor guidelines. Responsibilities for the Team Lead include all aspects of Revenue Cycle support including performance improvement, development, documentation, testing, training, and education. The Team Lead will assist management in examining processes to improve workflow and increase revenue, and will coordinate the annual audit work plan and Revenue Integrity Process Improvements.
Shriners Hospitals for Children is an EOE/Drug-Free, Smoke-Free Workplace
- Lead for Revenue Integrity Auditor personnel in coordination with the Corporate Revenue Integrity Director.
- Identifies and evaluates organization risk areas and provides auditing services related to potential or identified documentation and reimbursement issues.
- Serves as a subject matter expert and in a consultative role to various levels of the organization and work closely and collaboratively with all clinical department leaders.
- Compiles and analyzes data from industry sources to develop recommendations leading to potential revenue cycle opportunities for the organization.
- Performs research and analysis of charges, CPT coding, modifiers, and billing processes to ensure compliance with Medicare, Medicaid guidelines and other insurance payors and department policy compliance.
- Maintains current knowledge of and organizational compliance with state, federal, and other third-party payor billing, and reimbursement guidelines.
- Coordinates with the appropriate parties the complete/partial payment or repayment of claims, as described in the SHC Audit Policy, as findings are identified as either over or under payments in accordance with state, federal or payor guidelines.
- Conducts audits and reviews activities to improve the revenue cycle, claims production and coding integrity.
- Communicates or assists in communicating the results of audit and consulting projects via written reports and oral presentations to management.
- Develops, executes, and maintains detailed plans to improve revenue cycle and track and monitor key revenue cycle performance indicators and report key findings to appropriate leadership and stakeholders across the organization.
- Conducts root-cause analyses with Revenue Integrity Analysts and Clinical Department Managers to identify opportunities for error reduction post audit.
- Implements charge capture corrective measures and monitoring tools to ensure sustainability of changes; performs reviews, and monitors statistics and key performance indicators to identify improvement opportunities.
- Reviews data and systems to target areas of improvement.
- Experience with patient accounting systems, billing/claim submission software with Cerner experience a plus.
- Performs in a professional manner, exercising independent judgment, and ethical standards always.
- Represents Revenue Integrity by participating in committees and workgroups as requested.
- Ensures confidentiality of all audit reports generated by this department, working within the established SHC policies for protecting patient information.
- Reports directly to the Corporate Director of Revenue Integrity/Denials Management.