Covenant Health

Supervisor Revenue Integrity-Operations

Full time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals and over 85 outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees.

Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer. 

Position Summary: 

Responsible for supervision of clinical audit and appeals processes conducted by Revenue Integrity Department Auditors and Appeal Coordinators. Oversees audit and denials management workflow including quality and reporting. Provides departmental and auditor education regarding payer policies, coding, and charging practices. Maintains organizational and professional ethical standards and works with Covenant leaders to coach, mentor, and train department staff. Works independently under limited supervision with significant latitude for initiative and independent judgment. Works with Covenant Health entities to lead and conduct revenue cycle and compliance audit projects as they relate to charging, coding, documentation, and billing. Provides consulting services to the organization’s management and staff and may coordinate requested investigations. Coordinates annual audit plan. Maintains electronic audit tool. Oversees use and training of the denials management system.

Recruiter: Kathleen Rice || kkarnes@covhlth.com || 865-374-5386

• Identifies and evaluates company risk areas and provides auditing services related to documentation and reimbursement.
• Reviews ADR log, denial reports, and Payer websites to identify potential risks and trend data.
• Reviews and studies all information published by MAC, CMS, and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative to coding, billing, and reimbursement compliance in order to ensure compliance.
• Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure compliance.
• Performs research and analysis of charges, CPT coding, modifiers, and billing processes to ensure compliance with Medicare, Medicaid guidelines and other insurance payers and department policy compliance.
• Explains charges and charging procedures to third party insurance companies for defense audits as applicable.
• Coordinates with appropriate parties the complete/partial payment or repayment of the claims, as described in the Audit Policy, as findings are identified that are either over-payments or underpayments.
• Communicates or assists in communicating the results of audit and consulting projects via written reports and oral presentations to management.
•  Documents all audit activities in a designated location; reports statistics and identified problems monthly or more urgently if deemed necessary.
• Monitors audits performed at the department level in order to ensure that data is appropriate, being maintained, and being disseminated to leadership as indicated.
• Assists with payer denials when necessary.
• Performs data analysis of analytics in order to guide process improvement efforts, provide real-time education of our staff and physicians, and facilitate best practices.
• Oversees use and training of the audit tool and denials management system including policy and procedure development.
• Works with the department manager to assist with implementation of solutions to maintain a proper compliance stance.
• Works with Covenant Health entities to improve revenue cycle process and adhere to organizational compliance standards as they relate to charging, coding, documentation, and billing compliance.
• Works with the Chief Compliance Office relative to coding, billing, and reimbursement compliance issues.
• Works with the Chief Compliance Officer in the development and ongoing activities involved in the baseline and periodic compliance audits and compliance programs as deemed appropriate by manager.
• Works with contract management personnel in the review of contracts and other reimbursement or payment arrangements in relation to charging, coding, and billing compliance.
• Works closely with Financial Analysts to identify process improvement activities and audit opportunities as well as interpret payer appeals processes.
• Works closely with co-workers to identify process improvement activities and to reduce denials.
•  Advises, educates, and acts as clinical/billing liaison between CFOs, department managers, and billing staff to maximize reimbursement within compliance guidelines for Medicare, Medicaid and other insurance payers as deemed appropriate by manager in relation to denials, audit findings, and process improvement initiatives.
• Coordinates and facilitates problem resolution sessions where multiple departments and/or service areas are involved as deemed appropriate by manager.
• Maintains lines of communications with facilities in an ongoing effort to improve the overall quality of customer service.
• Motivates coworkers and promotes a team effort in accomplishing goals and deadlines with accuracy, dependability, and professionalism.
• Coordinates with staff to ensure necessary materials, equipment, and/or supplies are maintained utilizing all avenues of resource management in ordering supplies for departmental needs.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Minimum Education:           

Bachelor’s degree or Associate’s degree with related healthcare experience of five (5) or more years in revenue integrity, revenue cycle, or corporate compliance.

Minimum Experience:         

Three (3) to five (5) years of experience in health care. 

Licensure Requirement:       

None