Manager Revenue Integrity

Vail Health has become the world's most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital. This state-of-the-art facility provides exceptional care to all of our patients, with the most beautiful views in the area, located centrally in Vail. Learn more about Vail Health here .

Some roles may be based outside of our Colorado office (remote-only positions). Roles based outside of our primary office can sit in any of the following states: AZ, CO, CT, FL, GA, ID, IL, KS, MA, MD, MI, NC, NJ, OH, OR, PA, SC, TN, TX, UT, VA, WA, and WI. Please only apply if you are able to live and work primarily in one of the states listed above. State locations and specifics are subject to change as our hiring requirements shift.

About the opportunity

The Manager of Revenue Integrity oversees Vail Health's database of service offerings, codes, rates, pricing and ongoing Chargemaster maintenance and also manages the adherence to coding and workflows around coding as relates to finance and the chargemaster. The CDM Manager ensures the management of Revenue Cycle initiatives associated with Charge Capture, Charge coding and Charge Reconciliation. This position will direct all aspects of Charge Description Master (CDM), including but not limited to development of new charge codes, compliance with third party coding regulations, revision of existing codes, CPT/HCPCS updates, revenue code changes, pricing, and maintaining compliance with current local regulations as well as payer requirements.

What you will do

• Supervises, trains, and develops Revenue Integrity team members to ensure effective performance and adherence to best practices in revenue cycle operations.
• Oversees the maintenance of the Charge Description Master (CDM) to ensure accuracy, compliant effective and efficient operations. Work to implement strategies to improve charge capture and prevent revenue leakage.
• Develops CDM‑related departmental, division and/or organizational policies and procedures for recommendation and approval including but not limited to pricing, CDM audits, charge reconciliation, and charge capture. Create and execute work plans to successfully implement changes to systems and/or process as necessary.
• Leads efforts of multidisciplinary groups where necessary to monitor the completeness and accuracy of revenue and billing information.
• Leads organization RAC Denials team and works closely with the Patient Financial Services ("PFS") to track and monitor coding‑related denials.
• Coordinates and/or participates in system testing as a result of upgrades, changes, enhancements, new application implementations, etc. that may impact the CDM, charge capture and/or charge data flow between systems or modules.
• Analyzes financial and clinical data to identify trends, revenue improvement opportunities, and potential risks. Monitor key performance indicators (KPIs) and provide regular reports on revenue integrity performance.
• Partners with finance, billing, compliance, and revenue cycle to develop strategies and ensure alignment across departments.
• Actively promotes and participates in initiatives to improve organization effectiveness and efficiency.
• Works with departmental managers to ensure that clinical charges and billing codes are fully and correctly established in Electronic Medical Record patient care applications and are captured by Electronic Medical Record patient billing applications. Provides education as needed to departments related to their charges and charging practices.
• Regularly attends and actively participates in staff meetings, in‑services and continuing education programs as offered in order to remain current with organizational and industry changes. Communicate and disseminate information to other departments as applicable.
• Successfully maintains staff engagement and satisfaction scores for responsible departments based on periodic internal surveys at or above the stated organizational goal.
• Role models the principles of a Just Culture and Organizational Values.
• Must be HIPAA compliant.

This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

What you will need

Experience:

• Five years healthcare‑revenue cycle experience required, including two years in Revenue Integrity.
• Prior supervisory experience preferred.
• Demonstrated knowledge of laws and regulations pertaining to healthcare industry required.
• Prior healthcare financial experience or related field experience in a hospital/integrated healthcare delivery system preferred.
• Prior CDM or charge capture experience required.
• Proficiency in medical terminology, hospital charge masters, charge review, clinical record information systems, and coding methodologies required
• Prior experience leadin