West Suburban Medical Center, LLC

For over 100 years, West Suburban Medical Center has supported generations of families in the Oak Park and surrounding areas. Our kind, caring hospital staff have a passion to heal and make a difference in our community. We understand that our employees are the heart of our facility. If you are looking for a family atmosphere, a company committed to professional growth and a culture that embraces our five core values of Quality. Innovation. Service. Integrity. Transparency. 

PRIMARY JOB SUMMARY

The Manager of Revenue Integrity is a skilled and detail-oriented professional who will play a crucial role in minimizing revenue loss by efficiently managing and resolving denied claims through proactive denial management strategies. This position requires a strong understanding of healthcare billing processes, insurance regulations, and excellent communication skills. In addition, responsible for the maintenance, support and build of all RCM systems. 

PRIMARY JOB QUALIFICATIONS

• Bachelor’s degree in healthcare administration, Business, or a related field, recommended.
• Minimum of "6" years of experience in billing, denial management, revenue cycle, or a similar role within a healthcare setting.
• Proficient knowledge of medical billing, coding, denial mgmt. and insurance processes.
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Detail-oriented with a focus on accuracy and data integrity.
• Familiarity with healthcare compliance regulations.
• Prior supervisory experience. 

PRIMARY JOB DUTIES

• Review and analyze denied claims to identify root causes and trends.
• Collaborate with billing and coding teams to investigate and address coding errors, documentation deficiencies, and other issues contributing to claim denials.
• Work closely with billing, coding, and clinical teams to prevent denials through education and process improvement initiatives.
• Provide training sessions to staff members on denial prevention and resolution strategies.
• Maintain detailed records of denial-related activities, including appeals, resolutions, and key performance indicators.
• Stay informed about changes in healthcare regulations and payer policies affecting denial management.
• Ensure compliance with coding guidelines, documentation requirements, and other relevant standards.
• Conducts meetings with service line clinical departments to ensure accurate charge documentation, capture and workflows processes are in place. Identifies possible weaknesses in these processes and quantifies net revenue opportunities of such weaknesses.
• Assists in developing, with other related departments, changes to workflow processes and provides education and training to departmental staff to achieve net revenue opportunities.
• Representing the hospital and clinics, ensures all locations stay abreast of payor changes that impact reimbursement to include changes in authorizations and billing. Informs those departments as applicable.
• Ensures that coding, revenue codes, description nomenclature, patient billable versus non-billables, pricing, catalog development, updates (add/delete/change) and GL interfaces for all CDM items are appropriate.
• Works with coding resources to improve clinical and reimbursement policies, procedures, laws, and regulation related to charge capture and billing. Collaborates with coding personnel for changes in reimbursement rules as part of retrospective review process and newly introduced coding/billing guidelines to standardize coding and billing processes to include CDM maintenance.
• Responsible for the overall build and update to the CDM file.
• Coordinates ongoing monitoring and reviews to identify billing and system logic opportunities related to the CDM and facilitates the solutions for achieving the identified opportunities.
• Performs or coordinates data quality reviews ensuring revenue integrity and coding compliance audits to ensure OIG compliance. Monitors compliance with all federal regulations with NCD’s and LCDs for medical necessity.
• Assesses and processes all requested additions and changes to the CDM and works with the requesting clinical department's leadership and Revenue Integrity team to determine whether a process change(s) will be required.
• Responsible for final review and approval of CDM changes before processing into the EAP; Confirms charge appropriately represents clinical services or procedure prior to creation for billing use. Ensures maintenance and reconciliation of CDM updates.
• Evaluates validate underpayment work queues and reports and documents appropriate follow-up within the system.
• Responsible for a team of revenue analysts that will support the overall RCM functions within Resilience Health.
• Responsible for all tasks/ build necessary to support all RCM systems at Resilience Health.  

West Suburban Medical Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.