Note: The job is a remote job and is open to candidates in USA. Optum is a global organization that delivers care aided by technology to help millions of people live healthier lives. The Revenue Integrity Supervisor oversees West Region revenue integrity operations, including charge capture, pricing accuracy, reimbursement, chargemaster maintenance, analytics, payer compliance, and revenue cycle improvement initiatives.
Responsibilities
- Supervises daily revenue integrity operations, including payer payment and pricing applications, charge control processes, system updates as needed
- Maintains the chargemaster and fee schedules for West Region; completes annual and quarterly updates; documents approved changes; and coordinates annual CDM CPT/HCPCS updates
- Monitors charge-capture controls, including revenue reconciliation, change management, and supports departmental accountability for complete and accurate charges
- Reviews, works, and resolves Epic charge-related work queues and billing edits accurately and within established turnaround times
- Partners with Coding and clinical departments to identify and correct charge, billing, documentation, and coding errors in accordance with ICD, CPT, HCPCS, payer, and National Correct Coding Initiative requirements
- Serves as the primary service-line resource for charge-related questions, charge-code use, payer coverage, and payment requirements
- Identifies opportunities to optimize practice management and revenue cycle technology, integrate business intelligence tools, automate manual processes, and standardize reporting across the West
- Analyzes, validates, and distributes KPI dashboards, quality-control reports, monthly operational reports, and ad hoc analyses for Revenue Cycle, Finance, Clinical Operations, and other stakeholders
- Analyzes charges, payments, denials, and reimbursement trends to identify revenue gaps, short payments, noncompliance, and opportunities to accelerate collections and prevent revenue loss
- Conducts routine claim and chargemaster reviews, coordinates complex denials and payer audits, and escalates or troubleshoots claim and reimbursement issues with payers
- Monitors Medicare, Medicaid, and commercial payer guidance and medical policies; evaluates operational and financial impacts; and implement approved compliance changes with Revenue Integrity and operational leaders
- Meets with operational leaders to review revenue cycle metrics, identify trends and issues, and develop interim and long-term improvement plans
- Supports payer contract configuration in practice management systems and monitors payments against contractual terms to identify reimbursement variances
- Participates in revenue cycle improvement initiatives and completes other duties or projects that support organizational goals
Skills
- 2+ years of experience in Healthcare Revenue Cycle Operations including revenue integrity, reimbursement methodologies, denials, and process improvement
- 2+ years of experience in advanced analytics, delivering actionable insights from data, databases, and big data analytics environments
- Working knowledge of medical coding (ICD, CPT, HCPCS)
- Exposure to healthcare data from multiple sources: Payor claims processing, EDI, EHR
- Experience in working with multi-disciplinary teams and varying levels of leadership
- Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization process
- Intermediate proficiency with Microsoft products such as Excel, PowerPoint, Word, Project
- Solid problem-solving, critical thinking, and analytical skills
- Demonstrated comprehension of complex clinical and revenue integrated systems and processes
- Solid & efficient communication and customer service skills
- Ability to take direction from senior leadership but also be able to work independently with follow-through and handle multiple tasks simultaneously
- Solid verbal skills and ability to communicate abstract concepts in a simple format
- Solid organizational skills: ability to prioritize work; detail oriented
- Ability to educate and train all levels of professional staff
- Ability to be proactive, self-directing, and take initiative
- Ability to work efficiently under pressure
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Flexibility to work remotely from anywhere within the U.S.
- Career development opportunities
Company Overview
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