Little Axe Health Center / 15951 Little Axe Dr. / Norman, OK 73026
The Revenue Integrity Officer reports to the Health Compliance Officer to ensure compliance with all regulations, policies and procedures related to the revenue cycle for facility charges and physician services. The Revenue Integrity Officer reviews systems and processes to identify potential compliance issues, works with appropriate departments to correct such issues, serves as the internal resource for billing-related questions, provides training related to appropriate billing, and works with various departments to help ensure billing compliance. Performs other related duties as assigned to achieve the goals and objectives of the department and the organization.
The Revenue Integrity Officer will oversee, enhance, and maintain a properly functioning revenue cycle process through staff development, work integrity and team performance. The Revenue Integrity Officer is responsible to meet or exceed revenue, metrics and objective goals established for the department. Revenue Integrity Officer collaboratively with leadership to assist in development, project management and implementation of process enhancements or health system’s initiatives to enhance revenue cycle and compliance with applicable state and federal regulations. This position is also responsible for managing and auditing the ongoing daily operations of a section of the Health System’s Revenue Cycle. This position will work with Health Information, Patient Registration, Compliance Officer, Finance Director, Credentialing Team and Administration on all applicable projects. This position assists the compliance officer in providing support, feedback and direction to staff. This position is responsible for the management and analysis of revenue cycle initiatives, teams and functions.
Oversees and assists with compliance audits and investigations with a primary focus on revenue cycle by reviewing medical records for documentation compliance for CPT, HCPCS, and diagnosis codes determining that regulations are being complied with as evidenced in medical record documentation; and evaluating appropriateness of billing and coding procedures. Provides oversight and assistance all aspects of revenue cycle management with coding, claims, payment posting, aging, and all revenue cycle aspects. Requires knowledge of CPT, Level II HCPCS, diagnosis coding, and government payer regulations. Work involves actively directing and conducting internal coding/billing audits, investigations, corrective action plans, regulation research, staff and provider education, and proving consultative services to the organization’s senior leadership, providers and staff; providing key contributions to the development of the Compliance annual audit work plan, awareness and mitigation of revenue cycle risks; and providing training and coaching to staff. Maintains and promotes all organizational and professional ethical standards. Works autonomously under general supervision with considerable latitude for initiative and independent judgement.
Other duties as assigned.
Revenue Cycle Officer is responsible for management oversight of the business office to include, billers, coders, payment posters, medical reimbursement specialist, and reconciliation clerk to ensure supervising and coordinating aspects of the revenue cycle including training, internal auditing, billing, claims production, collections, productivity, and performance reporting.
Act as a resource for documentation, coding, claim review process, and billing questions for all Health Systems by staying up-
to-date with local, state, federal laws, regulations and guidelines, as well as monitoring payer bulletins, periodicals and web-sites to maintain revenue cycle knowledge.
Perform coding quality audits (monthly or weekly) of medical records to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines, CPT guidelines and health systems policies and procedures.
Completes capture of patient revenue in every area that generates charges, management in relation to charging mechanisms and triggers, ensuring clean handoffs between clinical departments, strategic pricing, denials management, billing management and clinical operations relations.
Fosters partnering relationships with the Compliance Officer, Health Information Management department, Credentialing department and other third parties to ensure the accuracy of fee schedules.
Oversees fee schedule maintenance and enhancement by analyzing departmental charges, identifying and implementing charge improvements, assisting individual departments with reconciling charge discrepancies, and determine the reimbursement impact of CPT revisions.
Coordinates with Finance, Compliance Officer, Health Information Management and other coding professionals to ensure that the codes contained in the master fee schedule are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing.
Review of monthly reports to provide educational feedback on areas of possible documentation improvement to staff and providers.
Provides on-going education, communication and meets with each medical coder and biller to review the results of each audit and provides feedback to resolve issues found in the audit with re-training or other educational methods
Assists Compliance Officer in planning and execution of compliance reviews, audits and activities.
Assesses changes in the regulatory environment; researches, investigates and responds to issues related to documentation, coding and billing.
Assists, coordinates and participates in the record/claims audit process, provides documentation and compliance education sessions to physicians and other staff.
Assist the Compliance Officer with other aspects/projects/tasks/reviews of the compliance program to assure compliance with applicable state and federal and CMS regulations.
Implement changes in workflows and ques with the goal of improving Absentee Shawnee Tribal Health System’s compliance in all aspects of operations, effectiveness and efficiency in billing and coding processes.
Revise, change, edit and monitor workflow with the goal of determining best practices to result in compliance and maximization of revenue.
Performs Gap Analysis of all the Revenue Cycle departments and makes recommendations for process improvements and training.
Designs, analyzes, and implements information and reporting systems to monitor, detect and correct variations in revenue cycle performance
Review reports to determine best practices and track performances of those practices and promote potential changes, as needed.
Resolves escalated issues that arise from operations and require coordination with other departments
Participate in Business Development initiatives to ensure proper compliance
Follow changes and policies within the industry, preparing plans and goals to grow with the changes; follow company policy changes and projections that may impact Absentee Shawnee Tribal Health System’s services and programs.
Administer and uphold all of the Health System’s policies and procedures; recommend changes and/or creation of policies and procedures to enhance compliance and revenue management
Communicate with Company’s employees and potential Business Associates as needed
Assists strategic sessions with management and health board of director to promote cost effectiveness of practices and procedures
Provide leadership with a monthly analysis and summary using industry standard key performance indicators of excellence.
Ensure collection and A/R goals are achieved
Oversees, writes, and implement rules for the claims scrubber to minimize the number of times claims must be touched for billing processes
Report all risks identified within the revenue cycle process
Identify all variable at onset which may affect revenue cycle both positive and negative, developing a strategic plan to either mitigated disruption or capitalize on improvement
Assist in preparation of reports to share with payers when discrepancies in reimbursement are uncovered
Create, prepare and distribute loss of discount reports to be shared with contracted payers for timely payment enforcement
Establish audit trails for investigation of adjustments, refunds, write-offs and collection efforts by internal and external audit firms
Preparation of payer scorecards to share with Manage Care Contract partners for use during contract renegotiations
Develop and maintain denial reports to use for root cause analysis of denials
Prepare reports or presentations to share the results of denial analysis with affected areas
Research, identify and analyze the impact of potential process changes after completion of root cause analysis of denials
Prepare and distribute monthly adjustment reports to clinical areas for continued education
Prepare and distribute monthly denial reports to specific clinical areas for follow up
Communicate regularly with the compliance officer, management and health board of director management as needed
Attend meetings and in-services as requested
Assist in producing, editing, revising various documents such as but not limited to; policies and procedures, job responsibilities, job expectations, performance appraisal forms, surveys, etc.
Train additional team members, as needed
Attend continuing education activities to maximize knowledge
Maintain needed education and certifications
Coordinate with Health System’s Compliance Committee
Participate in quality improvement programs as necessary
Continuously works towards the Health System’s goal and vision
Additional duties as assigned by Supervisor
Education Requirements and Qualifications
Bachelor’s degree from an accredited college in relevant subject such as business or healthcare. (Equivalent and relevant combination of education and experience may be considered in lieu of Bachelor’s degree)
Experience in E-clinical works Healthcare system for 3 years preferred
Must have a working knowledge of reimbursement regulations for all carriers especially Medicare, Medicaid and Managed Care.
Ten (10) years of experience in management of clinical billing or healthcare revenue cycle experience required with extensive knowledge of ICD-10-CM and CPT coding principles and guidelines
Extensive knowledge of federal regulations and policies pertaining to documentation, coding, and billing
Must know how to perform proper revenue and reimbursement capture.
Must be highly analytical, detailed and independent.
Proven communication, organizational, and leadership skills required.
Other education and experience substituted for above requirements require approval by Executive Director.
Must have a valid Oklahoma Driver’s License
Knowledge, Skills and Abilities
Extensive knowledge of revenue cycle and compliance procedures
Considerable knowledge of industry laws, regulations and policies
Ability to establish and maintain positive relationships with employees, management, clients, vendors and external contacts
Competent in Health Informatics Body of Knowledge and Practice
Knowledge of local, state and federal regulatory requirement related to the functional area.
Ability to conduct and interpret qualitative and quantitative analysis, financial analysis, healthcare economics and business processes, information systems, organizational development, health care delivery systems, project management or new business development.
Ability to manage, organize, prioritize, multi-task and adapt to changing priorities.
Ability to provide leadership and influence others.
Ability to foster effective working relationships and build consensus.
Ability to mediate and resolve complex problems and issues.
Ability to develop long-range business plans and strategy.
Ability to mentor, foster, and develop future management within the organization
Extensive experience with Tribal billing
Maintain integrity of the billing system and processes
Communicate effectively to manage employees directly and indirectly, producing optimal results
Ability to build a highly effective team.
Physical Requirements and Working Conditions
Must be able to sit, stand, stoop, bend or kneel for long periods of time.
Sitting or standing or walking for long period of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking hearing and visual acuity.
Frequent lifting (up to 15 lbs)
Occasional lifting (up to 30 lbs)
Native American Preference/EOE/Drug Free Workplace/Smoke Free Workplace
3 weeks 1 day ago
Tribal Preference/Native American Preference/EEO/Smoke Free/Drug Free Workplace Indian preference applies to all positions, but all resumes will be accepted.
Forward Completed Absentee Shawnee Tribe applications with resume to: Absentee Shawnee Tribe Human Resources Department 2025 South Gordon Cooper Dr. Shawnee, OK 74801 Fax: 405-273-2710 Email: HR@astribe.com