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Manager, Transplant Charge Review | Revenue Cycle | Full Time | Remote

This a Full Remote job, the offer is available from: Florida (USA)

Overview:

The Transplant Revenue Integrity Team Leader oversees and optimizes processes to accurately determine the applicability of services to the transplant cost report. This leader analyzes transplant cost data, closely tracks all associated revenue streams, and partners with Revenue Integrity and Compliance teams to ensure financial accuracy and prevent missed or lost revenue. The Team Leader ensures compliance with all relevant regulations—including CMS, CPT/HCPCS, and UB Revenue Codes—while also fostering education, cross-functional collaboration, and ongoing staff development to uphold the highest standards of revenue integrity for transplant services.

Responsibilities:

•Oversee and enhance process for determining applicability of services to transplant cost report.

•Analyze transplant cost data and track all related revenue streams to ensure financial accuracy.

•Collaborate with Revenue Integrity team members to identify and resolve missed revenue opportunities and prevent leakage.

•Ensure compliance with regulatory requirements (CMS, CPT/HCPCS, UB Revenue Codes) specific to transplant billing and tissue tracking.

•Support Compliance’s prospective and retrospective reviews of transplant coding, billing, and cost documentation.

•Develop and deliver staff training and education on revenue integrity practices for transplant services.

•Foster cross-functional collaboration with clinical, finance, IT, and compliance teams where needed.

•Set performance expectations, provide ongoing coaching, and manage staff development and performance.

•Ensure prompt communication and resolution of billing, coding, and revenue cycle issues with internal and external stakeholders.

•Collaborate with CDM owner to audit the transplant Charge Description Master (CDM) for accuracy and alignment with regulations.

Qualifications:

Minimum Education and Experience Requirements

Education:

Bachelor’s Degree in Business or Healthcare field required
Master’s Degree preferred

Certifications (Preferred):

Coding certification in at least one of the following: CPC, CPC-P, CPC-H
Certification in Auditing and/or Healthcare Compliance preferred

Experience:

Minimum five (5) years of experience in hospital reimbursement or revenue cycle/charge capture
Minimum three (3) years of supervisory experience required
In-depth knowledge of Hospital Charge Description Master (CDM), billing, and hospital inpatient and outpatient coding
Working knowledge of current Medicare and other regulatory billing guidelines

Knowledge, Skills, and Abilities:

Proficiency with personal computers, including working knowledge of Excel, Word, PowerPoint, Access, and mainframe programs
Strong analytical skills
Excellent written and verbal communication skills
Strong interpersonal skills with the ability to work collaboratively
Ability to coordinate, prioritize, and operate with minimal direct supervision
Ability to work effectively with a wide range of staff as part of an interdisciplinary team
Strong problem-solving and process improvement skills
Experience with extensive data mining and abstraction of financial and clinical information from various decision support tools, including support for charge master maintenance, revenue and reimbursement analysis, and ad hoc departmental reporting