Manager, Quality & Revenue Integrity
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AI Summary
Welcome to Ovation Healthcare!
At Ovation Healthcare (formerly QHR Health), we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions.
The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare’s vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior.
We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare, you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork.
Ovation Healthcare’s corporate headquarters is located in Brentwood, TN. For more information, visit www.ovationhc.com.
Summary:
The Manager of Quality Assurance & Revenue Integrity is responsible for leading initiatives that ensure the accuracy, compliance, and optimization of hospital revenue cycle processes while maintaining high standards of clinical documentation and regulatory compliance. This role partners internally and externally with clinical, coding, billing, compliance, and finance teams to reduce revenue leakage, ensure appropriate reimbursement, and uphold quality and regulatory standards. This role will monitor industry resources i.e., CMS, OIG, AMA etc. for audit trends, code changes and operationalize those topics in a proactive manner to Ovation services and alert leaders to potential concerns and trends.
Duties and Responsibilities:
Revenue Integrity Oversight
- Develop, implement, and maintain revenue integrity programs to ensure accurate charge capture, coding, billing, and reimbursement.
- Identify, analyze, and mitigate revenue leakage across inpatient, outpatient, and ancillary services.
- Conduct regular audits of charges, coding, billing edits, and reimbursement patterns.
Coding Integrity
- Collaborate with facility HIM & Compliance teams to ensure completeness and accuracy of medical records.
- Support accurate DRG/APC/ProFee assignment and appropriate reimbursement.
- Evaluate coding trends and provide education to coding staff, clinicians and other contacts.
Quality Assurance & Compliance
- Ensure compliance with federal, state, and payer regulations (CMS, HIPAA, OIG, etc.).
- Establish and maintain internal audit programs for clinical documentation, coding accuracy, and billing compliance.
- Prepare documentation and support external audits and regulatory reviews.
Knowledge, Skills, and Abilities
- Deep understanding of hospital revenue cycle processes to include CDM and reimbursement methodologies (DRG, APC, etc.)
- Strong knowledge of regulatory and compliance requirements (CMS, Medicare, Medicaid, commercial payers)
- Expert level with policy and procedure creation
- Advanced analytical and problem-solving skills
- Expert level in research for coding and payor guidelines
- Proficiency in healthcare IT systems (EHR, billing systems, auditing software)
- Able to multi-task across multiple EHRs and Encoders
- Proficiency in PowerPoint, Excel and Word
- Able to trend metrics with pivot table and percentages in Excel
- Ability to interpret complex data and translate into actionable insights
- Strong communication and leadership skills
- Able to coordinate, lead and/ or participate on huddles, groups and teams on projects to completion
- Detail-oriented with a focus on accuracy and compliance
Work Experience, Education, and Certifications:
5–8+ years of experience in healthcare revenue cycle, coding, auditing, or compliance
Strong experience and expert working knowledge with hospital billing (inpatient/outpatient), clinic, ancillary and other services areas and applicable code sets (ICD-10, CPT, PCS HCPCS, Modifiers), and payer regulations
3+ years in a leadership or managerial role preferred
One or more of the following: RHIA (Registered Health Information Administrator):
- RHIT (Registered Health Information Technician)
- CCS (Certified Coding Specialist)
- CPC (Certified Professional Coder)
- CHC (Certified in Healthcare Compliance)
Working Conditions and Physical Requirements:
- Remote role
Travel Requirements:
- 5%
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