• Employment Type: Full Time
• Shift: Days
• Location: Boston, MA

The Manager of Revenue Integrity and the Charge Description Master is responsible for supporting the enhancement and maintenance of properly functioning revenue cycle processes Tufts Medical Center as well as ensuring the integrity of the revenue charge capture system. In addition to supporting efficient revenue cycle functions, this individual assists with the management of a clinically driven revenue cycle review process to achieve a high standard of clinical quality while contributing to the organizations overall financial performance.

This position maximizes efficiency through 1) monitoring and supporting revenue cycle processes and staff functions; 2) aiding in ensuring the accuracy and integrity of the revenue charge capture system; 3) Managing the Charge Description Master

PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

• Manages multiple revenue cycle initiatives across the organization to improve processes and support optimal revenue cycle performance
• Oversees the revenue charge capture system to promote its accuracy and integrity across revenue- generating departments of the organization
• Works with department managers to help develop and implement policies and procedures for the purposes of reconciling charges posted in the billing system with other source information
• Manages a Revenue Integrity team that identifies opportunities for charge capture improvement by implementing and analyzing the results of routine, random audits
• Develops tools for the purposes of tracking and identifying potential areas of lost revenue
• Educates staff regarding the appropriate application of CCI, medical necessity, etc. edits
• Helps maintain and enhance the chargemaster; reviews organizational charge structures to assure that charges accurately reflect services and supplies provided and are consistent with current industry best practices Develops and provides reports to the Director of Health Information Management, CDM and other clinical leadership as required. Works closely with Nthrive, Tufts Medical Center Information Systems, Finance and clinical departments to assure high quality data. Educates staff on Nthrive and the ChargeMaster database as needed.
• Reviews changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable billing guidelines and optimization of reimbursement
• Ensures staff members are knowledgeable about documentation needs and coding and reimbursement issues identified through documentation reviews and aggregate data analysis
• Summarizes performance gaps and priority opportunities for improvement.
• Trains individuals for independent data base use.
• Monitors disparity outcomes and reports findings to appropriate Clinics/Departments.
• Makes informed recommendations on purchase of software and hardware, taking into account statistical analysis, database and data entry needs and future projected system capacity needs.
• Maintains collaborative, positive team relationships with peers and colleagues in order to effectively contribute to the working groups achievement of goals, and to help foster a positive work environment
• Performs other similar and related duties as required or directed.

ORGANIZATIONAL RELATIONSHIPS:

• Reports to Director of Health Information Management.
• Works with personnel of various levels within and outside Tufts Medical Center as directed.

JOB KNOWLEDGE AND SKILLS:

• At least 3 years of experience in managing healthcare business functions
• Knowledge of relational databases, report writing, and presentation software packages.
• Ability to present complex data and concepts to leadership, and other clinical and administrative leaders within the Tufts Medical Center community.
• Experience within an academic medical center preferred
• Knowledge of statistics and research methodologies.
• Working understanding of quality improvement and process improvement methodologies.
• Extensive knowledge of current healthcare trends, policies, and regulations
• Understanding of coding classifications systems such as, but not limited to, ICD-10-CM, CPT and HCPCS codes strongly preferred
• Competency in developing efficient and effective solutions to complex business challenges
• Strong leadership skills and commitment to a team approach
• Ability to influence key stakeholders at various organizational levels
• Comprehensive understanding of computer, database, and network technologies
• Exceptional verbal, interpersonal, and written communication skills
• Analytical skills needed to work independently with databases, manage budgets, develop policies and procedures, perform appropriate statistical analyses, etc.

EDUCATION:

• Bachelors degree in business, health or public administration, management, or a related field required

EXPERIENCE:

• Five years of experience working in health care field where position required database management.

An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.

Performance is Satisfactory when:

• Revenue and clinical quality continues to meet or surpass organization/industry standards
• Revenue cycle functions are completed with a high degree of quality and accuracy, and all interactions with staff are handled in a positive manner

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Normal office setting

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.