Manager of Revenue Integrity Compliance

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation's leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

The Revenue Integrity Compliance Manager is a highly motivated and detail-oriented. This role leads and oversees the organization's Revenue Integrity and Charge Description Master (CDM) compliance initiatives. This role is pivotal in ensuring adherence to the CMS Price Transparency Rule and other federal and state financial reporting requirements. The Revenue Integrity Compliance Manager is a strategic thinker with strong leadership skills and a collaborative mindset.

Key Responsibilities:

Develop, implement, and manage the Revenue Integrity & CDM Compliance Plan.
• Ensure compliance with CMS Price Transparency Rule and other applicable federal and state financial reporting regulations.
• Collaborate with cross-functional teams including Health Plan Operations, Patient Access, Marketing, IT, and Legal to streamline compliance processes.
• Design and execute weekly/monthly audit plans for compliance-related reporting activities.
• Coordinate with hospital end users and offshore teams to ensure accurate and timely deliverables.
• Lead the development and implementation of process automation tools to enhance compliance efficiency.
• Generate and distribute weekly/monthly compliance reports to stakeholders.
• Monitor regulatory changes and update internal policies and procedures accordingly.

Required qualifications:

1. Bachelor's degree in Healthcare Administration, Finance, or a related field of study is required (Combination of education and experience is also acceptable)
2. Minimum seven (7) years of experience in healthcare revenue cycle operations is required
3. Minimum three (3) years of experience in leading a revenue cycle function is required
4. Prior experience in interpreting different claim forms and remittances is required
5. Understanding of patient insurance benefit is required
6. Experience working with payers including Medicare, Medicaid, and commercial insurance is required
7. Understanding of CPT's, HCPCs, Diagnosis code, DRG code, EAPG, revenue code, etc. is required
8. Understanding of payor payment methods viz. Fee Schedule, RCC, Case rate is required

Preferred qualifications:

1. Experience working with Contract Management and Patient Access is preferred
2. Prior experience working with EPIC and Meditech preferred

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $97,760.00 to $141,440.00 on an annualized basis. The compensation estimate noted above is specific to California and has not been adjusted for any other geographic location. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf