Wilshire hires only the brightest and most experienced professionals in the healthcare revenue cycle management industry.  Wilshire will take the time to get know you and your employment history.  We will then place you in a role that will lead to a path of career success.  

Revenue Integrity Program Manager

About The Wilshire Group

The Wilshire Group is a boutique consulting firm in Los Angeles, California.  Our firm focuses on revenue cycle optimization as well as bringing a strong leadership team as the voice between operations and IT.  Our team has worked with over 100 healthcare systems across the US.  

 Our Values

• To be professional | To be efficient | To be flexible

This is a contract position for 3+ months.  This position offers $70-80 per hour.  This is 100% Remote position.

JOB DESCRIPTION

• Conduct prospective reviews of charge capture practices in the clinical departments and report findings, provide education to staff responsible for charge capture, coordinate charge capture improvement tools in collaboration with Revenue Cycle IT team, evaluate revenue impact, monitor ongoing compliance and expected versus actual revenue changes. Report potential compliance issues for further analysis and follow-up to the Compliance Department.

• Facilitate clinical SME use of Vitalware for submitting CDM requests with a focus on regulatory coding, compliance and adherence to internal guidelines regarding CDM maintenance, standard naming conventions and pricing integrity.
• Lead the approval of CDM new charges.
• Update and distribute regulatory guidance changes
• Create and distribute the monthly newsletter
• In collaboration with Compliance Department, provide education to clinical department staff regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliance use.
• Lead projects to improve revenue compliance, efficiencies in the charge capture process,and CDM charge structures.
• Perform basic financial analyses to report the impact of payment changes resulting frompayer practices and CMS regulation changes. Reports financial impact of charge capture practice changes and corrections to current practices. Communicate findings fully with clinical departments and executive team.
• Reviews EPIC WQs, conduct research needed to resolve the account issues and identify gross and/or net revenue benefit expected from all account corrections completed.
• Review Vitalware CCA file daily to discover and identify system compliance issues and revenue opportunities, conduct root cause analyses to correct identified charge capture issues, and report the gross and net revenue differential resulting from each discovery and correction completed.
• Develop criteria for reporting revenue performance to a variety of audiences including faculty, DFA’s, Division and Clinic Chiefs, the Director of Revenue Integrity, and others as appropriate.
• Responsible for presenting reports to a variety of audiences. Such reports will be accompanied by a thorough understanding of content and reasonable explanations for variations from the budget

Education Qualifications

• Bachelor’s Degree

 KNOWLEDGE/SKILLS & ABILITIES

• 5+ years of Epic experience
• Charge Description Master
• Revenue Integrity
• Vitalware

Wilshire is honored that you have taken the time to review/apply to our open position.  We will now take the time to review your experience and be in touch with you soon.