Manager - Professional Revenue Integrity

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This is a Stanford Health Care job.

A Brief Overview
The Manager of Professional Services Revenue Integrity oversees and leads a team of Revenue Integrity Program Advisors, ensuring the accuracy and completeness of revenue cycle processes related to charge capture, coding, billing practices, and compliance. This role ensures that all activities align with regulatory standards and organizational goals for Professional Services. The Manager is focused on improving charge capture, minimizing revenue leakage, and providing strategic direction to support the financial health of the organization. The Manager will collaborate closely with Chiefs of Staff, Directors of Finance & Administration (DFA's) at the School of Medicine, and their respective teams. This position will also work in partnership with coding, billing, and compliance departments to develop and implement best practices in revenue integrity that align with the financial objectives of clinical divisions while optimizing revenue streams. The role requires a strong understanding of revenue cycle management, healthcare regulations, and effective cross-functional team leadership.

Locations
Stanford Health Care

What you will do

• Serve as a key point of contact for senior leadership regarding the scope and work of the Revenue Integrity Program Advisors.

• Prepare and present reports on revenue integrity efforts, outcomes, and opportunities for improvement.

• Lead, mentor, and manage a team of Revenue Integrity Program Advisors, providing guidance, training, and performance management.

• Keep the team up to date on changes in healthcare regulations, coding updates, and industry best practices.

• Collaborate closely with clinical divisions to identify opportunities to enhance charge capture and optimize revenue. Proactively provide solutions to improve documentation and coding accuracy, ensuring clinical services are properly reflected in revenue.

• Act as a primary resource for clinical divisions, providing timely and clear responses to questions related to revenue processes, billing practices, and compliance. Address inquiries with a focus on transparency and regulatory adherence.

• Lead the intake and evaluation process for new services or service line proposals from clinical divisions, conducting research into financial impacts, compliance considerations, and resource requirements. Provide recommendations and strategic insights to clinical and operational leadership.

• Work with clinical divisions to understand their reporting needs and ensure that financial reports and revenue summaries are tailored to each division while finding opportunities for standardization. Use these reports to provide actionable insights and visibility into performance metrics.

• Regularly review and adjust the reporting package to reflect evolving needs or new service lines, ensuring it remains an effective tool for decision-making.

• Collaborate with clinical, billing, and coding teams to resolve discrepancies in charge capture and billing processes.

• Serve as a liaison between revenue cycle operations and clinical teams, streamlining communication and resolving discrepancies or questions related to charge capture, coding, and billing processes.

• Ensure that clinical departments receive timely updates on relevant changes and best practices to optimize efficiency and accuracy.

• Provide additional coverage to the Revenue Integrity Program Advisors as needed.

Education Qualifications

• Bachelor's degree in a work-related field / discipline from an accredited college or university. Relevant experience in lieu of degree may be considered (requires approval). Relevant experience in lieu of degree is in addition to the experience requirements for this position.

Experience Qualifications

• Seven (7) years of cumulative leadership experience. With at least three (3) years management or leadership experience in revenue cycle, clinical divisions, or otherwise related to charge capture, coding, or billing professional claims.

Required Knowledge, Skills and Abilities

• Ability to compile and deliver comprehensive reports to leadership, effectively showcasing trends, identifying areas for improvement, and offering actionable recommendations for strategic enhancements.

• Strong analytical skills to identify trends and opportunities in revenue data, with the ability to present findings to diverse audiences.

• Ability to mentor, inspire, and lead a team, maintaining agility and responsiveness to shifting priorities.

• Skilled in fostering a collaborative, organized, and efficient work environment, where team members can manage multiple requests, adapt to changing demands, and perform well under pressure.

• Keen attention to detail, particularly when reviewing reports related to coding, charge capture, and billing.

• Strong verbal and written communication skills, with the ability to translate complex operational or technical information into clear, concise presentations for leadership, clinical teams, and operational staff.

• Knowledge of healthcare regulations, including CMS guidelines, Medicare/Medicaid rules, and payer-specific requirements.

• Understanding of preference lists, order sets, and their impact on downstream charges.

• Experience with Epic EMR.

• Proficiency in SAP Business Objects (SAP BO) or similar reporting and analytics tools for business intelligence (BI) reports.

• Advanced skills in Excel and PowerPoint.

• Strong conflict resolution and negotiation skills to address discrepancies between clinical documentation and revenue cycle requirements, facilitating productive discussions between departments.

Licenses and Certifications

• CCS - Certified Coding Specialist preferred . or

• CPC and/or CCSP - Certified Professional Coder preferred .

Physical Demands and Work Conditions
Blood Borne Pathogens

• Category III - Tasks that involve NO exposure to blood, body fluids or tissues, and Category I tasks that are not a condition of employment

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.