Professional Billing Revenue Integrity Manager

at MaineHealth in Scarborough, Maine, United States

Job Description



Position Summary

The Professional Billing Revenue Integrity Manager is responsible for overseeing the daily operations of the PB Revenue Integrity team by effectively managing and participating in the team's goals of ensuring patient services are accurately charged, supported by clinical documentation, and that revenue is recorded in the proper practice. The PB Revenue Integrity Manager promotes charging compliance by effectively collaborating with the practice leaders and staff.

This position operationalizes the PB Revenue Integrity team's strategy and plan by 1) monitoring and supporting revenue integrity processes, productivity measures and staff functions; 2) aiding in ensuring the accuracy and integrity of the revenue charge capture across the health system; 3) collaborating with team members to steer projects related to charge capture for financial success.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

Education: Bachelor's degree in business, healthcare or a closely related field or eight (8) years of leadership experience within the revenue cycle in lieu of education required.

License/Certifications: Coding (COC, CPC, CCS, CIC), Clinical (RN), or Revenue cycle (CRCR) certification strongly preferred

Experience: Five (5) years' experience in Revenue Integrity or Revenue Cycle operations, healthcare industry. Proven proficiency or past experience in a management position in the following areas: charge integrity; charge reconciliation; charge compliance; project and performance management, productivity measures with performance outcomes.

Capacity to review, analyze and interpret data and analytics to root cause and implement corrective action.

EPIC HB/PB experience preferred.

Strong knowledge of revenue cycle processes and medical billing to include provider based, CAH, and RHC considerations. Strong understanding of billing guidelines and state and federal regulations with impact analysis.

Strong knowledge of code data sets to include CPT/HCPCS. Strong knowledge of NCCI edits, and Medicare LCD/NCDs.

Strong understanding of reimbursement models to include OPPS, HCC, and managed care.

Ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership and other billing or coding personnel.

Requires the ability to manage large complex projects assignments, investigate, analyze and resolve issues at a high level. Excellent communication, presentation, organizational, analytical and problem solving skills.

Must approach problem solving challenges independently, have strong attention to detail and enjoy working in a fast paced, collaborative team based environment.

Computer skills - MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.
Additional Information

With a career at any of the MaineHealth locations across Maine and New Hampshire, you'll be working with health care professionals that truly value the people around them - both within the walls of the organization and the communities that surround it.

We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow - programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family.
MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you're looking to build a career in a place where people help one another deliver best-in-class care, apply today.
Additional Information  MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at

MaineHealth values diversity and is an Equal Opportunity/Affirmative Action employer. Federal and state laws prohibit discrimination in employment because of race, color, national origin, religion, age, sex, sexual orientation, disability or veteran status.

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Job Posting: 992202

Posted On: Sep 29, 2023

Updated On: Oct 19, 2023

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