We are recruiting for a motivated RN Manager, Revenue Integrity to join our team!

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Department

Billing and Collections

Job Summary

The RN Manager, Revenue Integrity manages the Revenue Integrity program. Minimize revenue leakage through issue identification and root cause analysis, billing audits, denial review and drafting clinical appeals. Works in partnership with Compliance in review of third-party audits (Commercial & Government sources). Provides Revenue Integrity-related presentations, overviews, and recommendations related to denial trends and root cause analysis. Collaborates and assists in the resolution of problems causing payer denials, recoupments, and failed edits, as well as failed operational processes across the life-cycle of the claim through the revenue cycle teams. as they involve the charge capture, charge master and professional fee schedule, including clinical charging workflows. Educates and collaborates with members of the patient care team regarding billing, revenue cycle, denials management, charge capture, clinical documentation, and coding guidelines. Creates, implements and maintains the program's infrastructure (policies, procedures, audit processes, training processes, and metrics).

Essential Functions:

• Direct and participate in reviews of claims, charges, and clinical documentation to identify revenue leakage, compliance, and revenue cycle optimization. Receive clinical denials and review the medical record to draft appropriate timely appeals. Track outcomes to report out in a variety of settings. (20%)
• Manage the Revenue Integrity team. Oversee, assign and review work of the Revenue Integrity staff. Interview and hire new staff. Develop educational materials and provide staff training and develops educational materials. Perform all additional human resource functions such as timecard approval, scheduling, manage employee issues, talent management, team development, disciplinary actions, counseling, coaching, and appraisals. (20%)
• Manage and participate in risk assessments. Prioritizes risks and employs them as the basis for an annual documentation improvement, coding, and revenue cycle audit plan. Develop annual Revenue Integrity plan for enhancing compliance and reimbursements. (10%)
• Develop, maintain and report Revenue Integrity metrics and prepares Revenue Integrity reports and presentations including recommendations related to denial trends and root cause analysis of audit findings. (10%)
• Collaborate with all cross-functional departments within the Revenue Cycle and the Physician Advisors. Provide and assist in the development of education as needed. (10%)
• Develop and maintain all policies and procedures pertaining to the Revenue Integrity program and the Revenue Integrity staff duties. Keep policies and procedures current with changes in regulations and internal needs. (10%)
• Participate in the development and maintenance of Revenue Practice Teams (RPTs). RPTs are Revenue Integrity-led multidisciplinary groups that assemble a cross-functional team by designated service lines created to identify quick wins and long-term strategies by reviewing clinical documentation and revenue cycle workflows to support clean claims. (10%)
• Utilize LEAN processes to evaluate and optimize workflows in partnership with Revenue Cycle leadership. (10%)

Education:

• Bachelor's Degree Nursing (or Associates Degree with equivalent level of additional experience) Required

Work Experience:

• 4-6 years experience, including supervision, in medical/surgical nursing, utilization management, revenue cycle, or health information management Required
• 1-3 years Previous facility coding, clinical documentation, denial management, or utilization management experience preferred

Licenses:

• RN-Registered Nurse - DORA - Department of Regulatory Agencies Required

Knowledge, Skills and Abilities:

• Ability to exhibit knowledge and understanding of hospital and professional billing, coding, and charge capture.
• Ability to communicate and interact with physicians and other professionals by expressing ideas clearly and concisely and addressing audiences effectively. Ability to read and interpret financial reports, and legal documents as necessary.
• Ability to write reports, procedure manuals, and prepare business correspondence.
• Ability to assess and collect data, establish facts, and draw conclusions regarding clinical conditions.
• Ability to interpret an extensive variety of technical instructions and manage several abstract and concrete variables.
• Knowledge of training concepts and principles. Knowledge of various documentation/coding information systems, medical necessity, clinical documentation concepts, DRG assignments.
• Must have current knowledge of Medicare-Medicaid rules-regulations.
• Certifications in Revenue Integrity, Revenue Cycle, Finance, Compliance, CDI, Utilization Managment, or Coding Preferred

Shift

Work Type

Regular

Salary

$96,900.00 - $150,200.00 / yr

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program 

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.

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