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We are recruiting for a Director, Revenue Integrity to join our team!

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DepartmentBilling and Collections

Job Summary

Under minimal supervision, the Director of Revenue Integrity role has responsibility and accountability for developing strategies and ensuring efficient and compliant revenue processes which ensure that the organization collects all revenue to which it is entitled while maintaining compliance. Areas of responsibility include charge capture, charge reconciliation, charge maintenance CDM pricing strategy, charge edits, clinical denials, RAC audits, revenue cycle regulatory monitoring, and multidisciplinary clinical, operational, and financial revenue practice teams. This role identifies and partners with departments to reduce revenue leakage through impact studies, revenue reviews, and industry best practice. They will have experience working in a large, complex, matrix organization, and will have proven leadership experience and a demonstrated track record of leading a large health system through transformations resulting in performance improvement and training. The ability to have a significant impact on standardization and improvement of operations to align with leading practices will be critical to this role.

Essential Functions:

Manages, coordinates, and champions multiple revenue cycle initiatives across the organization to improve processes and support optimal high-performing revenue cycle operations (15%) Sets strategy and oversight of Revenue Practice Teams (RPTs). RPTs are Revenue Integrity-led multidisciplinary groups that assemble a cross-functional team by designated service lines created to identify quick wins and long-term strategies by reviewing clinical documentation and revenue cycle workflows to support a clean claim. Focus areas include standardizing, optimizing, educating, payer contract payment performance, payment variance reviews, and corrective or escalation actions to reduce revenue leakage through usage and implementation of Revenue Guardian and other Epic based reports. (10%) Oversee the Charge Edits team areas of focus including NCCI edits reviews, intervention, and review of patient accounts requiring additional oversight, processing corrected claims and compliance audit rebills. Charge Edits team assists with denials research from internal departments and third-party agencies. (10%) Directs the maintenance of the CDM (Hospital and Physician Billing) by incorporating new charges/services identified by internal stakeholders, third-party resources, CMS special requirements, and coding updates. Oversees the monitoring and change management practices for the CDM, revenue routing, fee schedules, and client agreements while maintaining consistency with third-party, regulatory oversight agencies and legislative requirements. Ensures codes contained in the CDM and fee schedules are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing. Analyzes CDM and makes recommendations for improvement or reimbursement maximization. Continually evaluates CDM for "lesser of" charge issues. Acts as champion or business owner of external vendors that provide CDM and CDM - related products. (20%) Participates in various IT-related steering committees for information technology changes that affect the revenue cycle. Champions design, build, and implementation of revenue-generating clinical services within Epic and other IT platforms. (5%) Promotes and oversees process improvement opportunities for charge capture improvement. Provides direction and oversees the charging charge methods are applied consistentl and accurately at the care site and supporting areas through the appropriate owner assignment and tools. Oversees revenue optimization identification and education departments with respect to the use and maintenance of the CDM and charging philosophy. Works collaboratively with the revenue-producing department leadership and clinical care sites to ensure all charges are being documented, captured, and reconciled. (10%) Directs program responsible for clinical appeals related to final denials prepared by RNs. Provides executive-level Revenue Integrity-related presentations, overviews, and recommendations. Collaborates and assists in the resolution of problems causing payer denials, recoupments, and failed edits as they involve the charge capture, charge master and professional fee schedule, including clinical charging workflows. (10%) Oversight of the team managing the Medicare and Medicaid RACs, government billed claims and inpatient stay reviews, and commercial payer audit and recovery programs. Communicates trends and presents executive updates to Compliance, Utilization Review, and Finance leadership. Partners with internal counsel and external vendors during all levels of the appeal process including settlement conferences and trials. Maintains and monitors high success rates in the audit program. (10%) Directs human resource functions such as interviewing, selection, orientation, education/training, feedback, performance evaluation, and policy and procedure development. Oversees the maintenance of personnel files, including documentation of appropriate staff orientation, competency, training, discipline, and performance reviews. Oversees department timekeeping and payroll. Collaborates with HR concerning employee issues and performance. Conducts employee coaching, counseling, disciplinary actions, and annual appraisals. Ensures staff adherence to hospital and departmental policies and procedures. Participates in the Talent Management program, including mentoring and providing development opportunities... For full info follow application link.

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