Program Integrity Jobs in Wyoming (NOW HIRING)

A Day in the Life of a Revenue Integrity Administrator:

HYBRID role - 3 days per week on-site, must live in Wyoming or Colorado!

As the lead of the Revenue Integrity Division, the Revenue Integrity Administrator defines and carries out the strategy for maximizing gross and net revenue captured across the health system. The Administrator serves as the chief liaison between Revenue Cycle Administrator, Revenue Integrity Medical Director, and clinical departments. This position will also ensure the availability and interpretation of reporting and analytics necessary for the clinical and Revenue Cycle departments to drive financial improvement. This position oversees the following functions: hospital/facility coding, Clinical Documentation Improvement, revenue reconciliation, Revenue Guardian, payment validation, and avoidable write-off prevention, and reporting and analytics.

Why Work at Cheyenne Regional?

• 403(b) with 4% employer match
• ANCC Magnet Hospital
• 21 PTO days per year (increases with tenure)
• Education Assistance Program
• Employee Sponsored Wellness Program
• Employee Assistance Program
• Loan Forgiveness Eligible

Here is What You Will Be Doing:

• Leads and oversees organization-wide Revenue Integrity and charge capture functions.
• Assist clinical departments with the deployment and continuous performance improvement efforts, for accurate and compliant charge submission. Drive execution and transformational change and leading-edge operations to contribute to Cheyenne Regional’s financial success.
• Assists annual price adjustment process through pricing models and vendor contract management variance reporting.
• Oversees Revenue Guardian, charge capture, reconciliation, and charge interfaces to ensure accurate charges across the healthcare organization.
• Collaborates with billing departments to establish and maintain charge capture audit processes, to check for appropriate coding and areas of potential revenue leakage.
• Collaborates with the Revenue Leadership Team to develop and execute monitoring tools to ensure effectiveness of revenue cycle projects and processes related to revenue capture (Accounts Receivable (AR) Days, timeliness of charge capture, Discharged Not Final Bill (DNFB), etc.) and automated processes.
• Manages and overseas development of policies, processes and workflows for hospital and professional coding, reviewing coding, medical necessity and level of care denials to ensure organizational best practices.
• Collaborates with Compliance department to ensure billing practice meets requirements across the health system.
• Oversees and manages the division’s budgetary and fiscal goals for reach of the departments.
• Analyzes patient estimates and provides guidance and reporting to assist patient experience.
• Reviews, analyzes and monitors organizational dashboards.
• Collaborates with the Revenue Cycle Administrator and Medical Director of Revenue Integrity to meet organizational goals and metrics relative to charging and coding of accounts.
• Participates in the Billing Grievance Committee to assist in monitoring and facilitating policies and regulatory compliance while meeting patient expectations.
• Participates, implements, and maintains Lean Methodology within the Revenue Integrity Division.
• Collaborates with clinical, financial, and operational departments to ensure optimal financial performance while maintaining high standards of accuracy, compliance, and efficiency.
• Collaborate with the Medical Director of Revenue Integrity to engage medical staff for denial prevention and documentation improvement initiatives

Desired Skills:

• Ability to apply appropriate management and leadership techniques and to manage multiple staff members in an operational setting.
• Advanced level of communication (verbal and written), interpersonal skills, problem solving, and organizational skills to maintain a high level of production and accuracy in an extremely task driven environment.
• Experience using Excel, PowerPoint, and Word.
• Excellent ability to understand and interpret statistical reports and perform quantitative analysis.
• Advanced skills in critical thinking and problem solving in a variety of settings and translation of data into actionable steps.
• Knowledge of insurance claim processing and third-party reimbursement.
• Knowledge of state and federal regulations as they pertain to billing processes and procedures.
• Knowledge of various types of provider reimbursement methodologies including per diems, inpatient Diagnosis-Related Groups (DRG)/All Patient Refined Diagnosis Related Groups (APRDRG) case rates, percent of charges, and outpatient surgery case rate methodologies
• Knowledge of Revenue Cycle processes, medical billing and coding processes, detailed accounting principles, quantitative decision making, and process analysis
• Ability to work independently, delegate responsibility, and take initiative across multiple workstreams
• Time management and project management skills

Here is What You Need:

• Bachelor's Degree or higher in Business Administration, Health Care Administration, Clinical Administration, Finance, and/or related field
• Eight (8) or more years of hospital Revenue Cycle, Revenue Integrity, and/or reimbursement experience
• Seven (7) or more years of management experience, with an emphasis on project management

Nice to Have:

• Master's Degree or higher
• Coding Certification to include, RHIA, RHGIT, CPC, CIC, CCA
• Healthcare Financial Management Association certification

About Cheyenne Regional:

Cheyenne Regional Medical Center was founded in 1867 as a tent hospital by the Union Pacific Railroad to treat workers injured while building the transcontinental railroad. Today, we are the largest hospital in the state of Wyoming, employing over 2,000 people, and treating over 350,000+ patients from southeastern Wyoming, western Nebraska, and northern Colorado. We pride ourselves on patient and employee experience by living our core values of Integrity, Caring, Compassion, Respect, Service, Teamwork and Excellence to great health.

Our team makes a difference every day by providing trusted healthcare expertise through a passionate and I.N.S.P.I.R.E.(ing) approach with a personal touch. By living our values, we aim to achieve our goal of becoming a 5-star rated hospital, providing critical support and resources to our community and the greater region we serve. If you are eager to make a difference and passionate about healthcare, we encourage you to apply today!