Revenue Integrity Analyst Manager

Company Overview

Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family’s ability to pay or insurance status. Please click here to learn more about our locations.

CURRENT EMPLOYEES: Please log into Workday Click Here to apply internally through the "Jobs Hub"

Job Description

The Revenue Integrity Manager is responsible for management and coordination of all Revenue Integrity charge capture activities throughout the SC organization. This includes the development of processes and procedures necessary to ensure accurate and timely capture of all chargeable procedures and oversight of all charge reconciliation processes. Also responsible for maintaining communication with key stakeholders regarding updates to charge capture processes to ensure charge capture accuracy is maintained and adhered to throughout SC. Performs oversight of process adherence through regular reviews of chargeable services and activities throughout SC and provides feedback and education to SC Senior Leadership, Service Line Leaders and colleagues on process improvements and areas of opportunity for revenue enhancement.

Key Responsibilities:

• Responsibilities include all aspects of Revenue Cycle support including performance improvement, documentation, development, testing, training, upgrades, and assist management and senior leadership in examining processes to improve workflow.

• Compiles and analyzes data to develop recommendations leading to potential revenue cycle opportunities, include analyses related to CDM set-up, charge capture, and billing.

• Provides analysis, trended reports and well supported documentation for audit findings, recommendations and/or corrections to individual hospital processes according to best practice, compliance and SC policy.

• Maintains knowledge of an organizational compliance with state, federal, and other third-party payer billing and reimbursement guidelines.

• Conducts charge capture assessment activities including interviews, research, and outcomes analysis. Provides analysis, well-supported documentation and recommendations for changes, additions and/or corrections to the CDM according to best practice and company standards.

• Provides support, communication and education to multiple facilities and corporate staff on correct charge capture, billing and coding processes, and state and federal guidelines.

• Assists in identifying, defining, and functioning within current software processes (i.e., Craneware, EPIC); review and/or development of reports and audit tools to support the requirements for revenue integrity and outcomes measurement.

• Performs audits with a focus on revenue cycle integrity, assists in the development and implementation of charge practices and conducts root-cause analyses with Revenue Integrity Analysts to identify opportunities for error reduction.

• Tracks and monitors key revenue cycle performance indicators; reports key findings to appropriate leadership and stakeholders across the organization.

• Manage the performance and productivity of the team as it relates to CDM maintenance and charge capture processes.

• Consistently complete performance monitoring processes and implement corrective actions as required.

• Ensure revenue integrity and clinical department staff comply with established Revenue Integrity/Revenue Cycle policies, processes and quality assurance programs.

• Support rollout of process improvements through the charge capture functions.

• Maintain up-to-date knowledge of regulatory and compliance changes impact the CDM, charging requirements and operations and ensure revenue integrity and charge champion and service line leaders are appropriately educated and the CDM charging tools and processes are modified as need to capture revenue for services rendered.

• Proactively works with department leaders to provide education as it pertains to changes in charge capture in accordance with local/nation and payor guidelines.

• Effectively and professionally communicates results, challenges and solutions through daily interaction, regular reports, and monthly status meetings with Corporate Director of Revenue Integrity/Denials Management and/or Executive Director of Revenue Cycle.

• Completes special projects, as directed by the Corporate Director of Revenue Integrity/Denials Management and/or Executive Director of Revenue Cycle; provide other support as needed.

• Leads the Revenue Analyst team by providing feedback, constructive critique of work and job performance, and plans and organizes the functions and activities of the team to ensure department and corporate goals are met.

• Develops and maintains effective relationships and communications with leaders, technical/application teams and external customers.

• Responsible for Epic Resolute HB/PB and Resolute HB/PB Claims, as well as other related billing applications.

• Prepare and execute functional system and program specifications using structured methodology.

• Serve as a subject matter expert on assigned project teams and department initiatives, develop test scripts, conduct testing, support application upgrades and project go lives.

• Utilize advanced application & analytic skills to design, build and test solutions to meet the needs of the organization.

Required Qualifications:

• Bachelor’s degree in business/accounting/finance or healthcare/business administration

• 10 or more years of hospital/clinic-based revenue cycle experience focused on revenue integrity and compliance.

• 5 or more years of hospital-based billing, coding, and charge capture experience. Proficient knowledge of charge master components) CPT codes, HCPCs, Revenue Codes, GL and cost Centers.

• Charge capture, billing, or coding experience to include pharmacy, radiology, surgery/anesthesia, outpatient clinic, and inpatient hospitalization.

• Five or more years of Epic PB and HB experience

• Partner with Patient Financial Services, Finance, Compliance, Information Services, and other departments on revenue management initiatives and strategic planning.

Preferred Qualifications:

• Master’s degree

• Applicable clinical or professional certifications and licenses desirable.

• HFMA, AAPC, CPC, CRCT

• Epic HB/PB certification

Originally posted on Himalayas