Revenue Integrity Program Manager

Are you ready to make a significant impact within a leading healthcare organization dedicated to pioneering patient care and operational excellence? This is an incredible opportunity to step into a pivotal role where your expertise will directly shape the financial health and compliance integrity of a complex, dynamic environment. You will be the vital link between clinical operations and revenue cycle optimization, ensuring that every service provided is accurately captured and compliant, directly contributing to the organization's mission of delivering an exceptional patient and family experience. Join us, in partnership with Aquent, and become a key driver in maximizing revenue generation and fostering a culture of financial accountability.

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

**About the Organization:**

Our client is a prominent healthcare institution renowned for its commitment to advanced medical research, innovative treatments, and delivering world-class patient care. They are at the forefront of medical discovery, striving to improve human health through compassion, collaboration, and a relentless pursuit of excellence. This organization fosters an environment where dedication to patient well-being is paramount, and every team member plays a crucial role in achieving their ambitious goals.

**About the Role:**

We are seeking a highly skilled and proactive leader to champion revenue integrity across our client's operations. In this role, you will be the trusted expert, driving compliance, optimizing revenue, and ensuring the seamless integration of financial processes with clinical services. You will empower clinical departments and leadership with the knowledge and tools needed for accurate charge capture, conduct vital analyses, and lead initiatives that directly enhance the organization's financial performance and regulatory adherence. This is a chance to apply your strategic thinking and analytical prowess to make a tangible difference in a healthcare system that values innovation and patient-centered care.

**What You'll Do:**

* Conduct prospective reviews of charge capture practices, report findings, and provide essential education to staff on best practices.

* Coordinate the implementation of charge capture improvement tools in collaboration with Revenue Cycle IT teams, evaluating revenue impact and monitoring ongoing compliance.

* Report potential compliance issues for thorough analysis and follow-up with the Compliance Department.

* Facilitate subject matter expert engagement for submitting Charge Description Master (CDM) requests, focusing on regulatory coding, compliance, and adherence to internal guidelines for CDM maintenance, naming conventions, and pricing integrity.

* Collaborate with the Compliance Department to educate staff on CPT, HCPCS, revenue codes, and modifiers for compliant use.

* Lead projects aimed at enhancing revenue compliance, improving efficiencies in the charge capture process, and refining CDM charge structures.

* Perform financial analyses to report the impact of payment changes due to payer practices and regulatory adjustments, communicating findings to relevant teams and executive leadership.

* Review work queues, conduct research to resolve account issues, and identify gross and/or net revenue benefits from account corrections.

* Daily review audit files to identify system compliance issues and revenue opportunities, conduct root cause analyses, and report the gross and net revenue differential resulting from corrections.

* Develop criteria for reporting revenue performance to various leadership and departmental stakeholders.

* Present comprehensive reports to diverse audiences, providing thorough understanding of content and reasonable explanations for variations from budget.

* Clear various daily work queues (e.g., Claim Edit, Charge Router, Account).

* Prepare monthly reports and analyses for financial and charging issues/trends for service lines.

* Research and respond to inquiries from service lines.

* Support taskforce efforts and participate in Objective & Key Results (OKR) initiatives for the team.

* Attend and actively participate in team huddles and meetings.

* Undertake other tasks and projects as assigned by leadership.

**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.

* Strong interpersonal skills for effective communication with clinical staff and faculty.

* Comprehensive knowledge of coding conventions.

* Current knowledge of third-party payer rules and regulations.

* Knowledge of computer systems and related interfaces.

* Knowledge of management and supervision principles, with the ability to organize staff's work.

* Excellent written and verbal communication skills to articulate analyses performed.

* Demonstrated ability to provide leadership in problem identification and issue resolution.

* A track record of influencing outcomes through data-supported arguments.

* Exceptional critical thinking skills for addressing complex issues and situations.

* Proven ability to mediate and solve complex work problems.

* 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 (CCSP)

* Registered Health Information Technician (RHIT)

* Registered Health Information Administrator (RHIA)

The target hiring compensation range for this role is $65.00 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. 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