Employment Opportunities

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 appropriates 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 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 records 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.

• 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 system policies and procedures.
• Complete 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.
• Foster partnering relationships with the Compliance Officer, Health Information Management department, Credentialing department and other third parties to ensure the accuracy of fee schedules.
• Oversee fee schedule maintenance and enhancement by analyzing departmental charges, identifying and implanting charge improvements, assisting individual departmental with reconciling charge discrepancies, and determine the reimbursement impact of CPT revision.
• Coordinate 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.
• Provide 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.
• Assist Compliance Officer in planning and execution of compliance reviews, audits and activities.
• Assess changes in the regulatory environment; researches, investigates and responds to issues related to documentation, coding and billing.
• Assist, coordinate and participate 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 programs 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 monito workflow with the goal of determining best practices to result in compliance and maximization of revenue.
• Perform Gap Analysis of all the Revenue Cycle departments and makes recommendations for process improvements and training.
• Design, analyze, and implement 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.
• Resolve escalated issues that arise from operation and require coordination with other departments.
• Participate in Business Development initiatives to ensure proper compliance.
• Follow changed 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 ate 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 changed 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-service 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.
• Perform other related duties as assigned.

• 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)
• Associate degree / Certified Provider Credentialing Specialist (CPCS) / Certified Professional Medical Services Management (CPMSM).
• Equivalent and relevant combination of education and experience may be considered in lieu of Associate degree.
• 8-11 years of previous credentialing experience within a healthcare environment.
• 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.
• Extensive experience with Tribal billing.
• Previous experience working with Native American entity preferred.
• 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 contact.
• Competent in Health Informatics Body of Knowledge and Practice.
• Knowledge of local, state and federal regulatory requirement related to the functional area.
• Must know how to perform proper revenue and reimbursement capture.
• Other education and experience substituted for about requirements require approval by Executive Director.

• Must be highly analytical, detailed, and independent.
• Proven communication, organizational, and leadership skills required.
• Knowledge and understanding of the credentialing process.
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent verbal and written communication skills including, letters, memos and emails.
• Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization.
• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
• Ability to conduct and interpret qualitative and quantitative analysis, fictional 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.
• 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.
• Must have a valid Oklahoma Driver’s License.
• Must be able to pass a background check and drug test.

• 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)

The Absentee Shawnee Tribe of Oklahoma (AST) is committed to Equal Employment without regard to race, religion, color, gender, national origin, age, disability, or sexual orientation. However, in accordance with the Indian Preference Act (Title 25 U.S. Code 472 and 473) preference in filling vacancies are given to qualified Indian candidates. AST will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990 and its amendments.

Native American Preference/EEO/Drug Free/Smoke Free Workplace