Revenue Integrity Program Manager

Join a leading healthcare organization dedicated to delivering exceptional patient care and advancing medical innovation. This institution is at the forefront of providing high-quality health services, driven by a mission to improve lives through compassionate care and cutting-edge research. As a key player in the healthcare landscape, the organization fosters an environment of collaboration and excellence, constantly striving to optimize operational efficiency and ensure financial integrity to support its vital mission.

To be considered for this role, you must:

• Be authorized to work in the United States
• Not require sponsorship of any kind for the duration of the assignment
• Be able to work on a W-2 basis. C2C or 1099 is not permitted for this position

Are you a seasoned revenue cycle expert with a passion for optimizing financial performance and ensuring compliance in a dynamic healthcare environment? We are seeking a highly motivated and analytical professional to step into a pivotal role that directly impacts our financial health and operational efficiency. In this position, you will be the crucial link between clinical operations and revenue cycle integrity, driving initiatives that enhance charge capture, reduce denials, and ensure regulatory adherence. Your expertise will directly contribute to the financial stability of our organization, enabling us to continue providing outstanding patient care and supporting groundbreaking medical advancements. This is an exciting opportunity to lead impactful projects, collaborate with diverse teams, and make a tangible difference in a leading healthcare institution.

What You'll Do:

• Conduct prospective reviews of charge capture practices across clinical teams, report findings, and provide essential education to staff.
• Coordinate the implementation of charge capture improvement tools in collaboration with IT teams, evaluating revenue impact and monitoring compliance.
• Identify and report potential compliance issues for further analysis and follow-up with the compliance department.
• Facilitate clinical subject matter experts in utilizing specialized software platforms for submitting Charge Description Master (CDM) requests, ensuring regulatory coding, compliance, and adherence to internal guidelines for CDM maintenance, naming conventions, and pricing integrity.
• Collaborate with the compliance department to educate clinical staff on current procedural terminology (CPT) codes, healthcare common procedure coding system (HCPCS) codes, revenue codes, and modifiers, emphasizing their compliant use.
• Lead projects aimed at enhancing revenue compliance, improving efficiencies in the charge capture process, and optimizing Charge Description Master (CDM) structures.
• Perform financial analyses to assess the impact of payment changes driven by payer practices and regulatory updates.
• Report the financial implications of charge capture practice changes and corrections, communicating findings to clinical teams and executive leadership.
• Review electronic health record work queues, conduct research to resolve account issues, and identify gross and net revenue benefits from account corrections.
• Daily review specialized software files to identify system compliance issues and revenue opportunities, perform root cause analyses for charge capture issues, and report resulting gross and net revenue differentials.
• Develop comprehensive criteria for reporting revenue performance to diverse audiences, including faculty, finance and administration directors, and clinical leadership.
• Present detailed reports to various stakeholders, providing thorough explanations for content and budget variations.

Must-Have Qualifications:

• Bachelor's degree in a work-related discipline/field from an accredited college or university (or equivalent combination of education/experience).
• Five (5) years of progressively responsible directly related work experience.
• Ability to analyze revenue data, identify trends and opportunities, and present such data to a variety of audiences.
• Exceptional interpersonal skills for effective communication with clinical staff and faculty.
• Strong knowledge of coding conventions.
• Current knowledge of third-party payer rules and regulations.
• Proficiency with electronic health record systems and related interfaces.
• Knowledge of management and supervision principles, with the ability to organize staff's work.
• Excellent written and verbal communication skills for presenting analyses.
• Proven ability to provide leadership in problem identification and issue resolution.
• Capacity to influence outcomes through data-supported arguments.
• Strong critical thinking skills to address complex issues and situations.
• Ability to mediate and resolve complex work problems.
• Demonstrated ability to effectively facilitate work groups to successful outcomes.

Nice-to-Have Qualifications:

• Certified Outpatient Coder (COC)
• Certified Professional Coder - Hospital (CPC-H)
• Certified Coding Specialist (CCS)
• Certified Professional Coder (CPC) and/or Certified Coding Specialist - Physician-based (CCSP)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)

The target hiring compensation range for this role is $81.96 to $87.33 an hour. Compensation is based on several factors including, but not limited to education, relevant work experience, relevant certifications, and location.

About Aquent Talent:

Aquent Talent connects the best talent in marketing, creative, and design with the world's biggest brands.

Our eligible talent get access to amazing benefits like subsidized health, vision, and dental plans, paid sick leave, and retirement plans with a match. We also offer free online training through Aquent Gymnasium. More information on our awesome benefits!

Aquent is an equal-opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics. We're about creating an inclusive environment-one where different backgrounds, experiences, and perspectives are valued, and everyone can contribute, grow their careers, and thrive.

#LI-GS1