Director of Revenue Integrity

Job Summary:

The Director, Revenue Integrity is responsible for the daily operations of Revenue Integrity including leading and planning the revenue cycle operations for all aspects of hospital and professional charge corrections. This position is responsible for establishing, designing, implementing, and enforcing charging and reconciliation policies and procedures, as well as streamlining and creating effective charging processes across multiple departments and service lines. The goal of this department is to ensure that revenue leakage is minimized. This position is highly visible and requires a strong leader with the ability to influence, prioritize, plan, multi-task, and direct the revenue integrity team members.

Scope: Institution-wide

Responsibilities:

• Responsible for the oversight of hiring, performance evaluations, and all team member human resource activities.
• Establish clear communication expectations within the department related to revenue integrity findings and identified risks/concerns.
• Provide tailored direction for the department to execute tasks that tie back to the goals of the organization as a whole and the revenue cycle specifically.
• Monitors revenue integrity key performance indicators and takes corrective action as needed.
• Develops and enforces specific revenue integrity objectives and performance standards for all team members.
• Maintains knowledge of all compliance regulations, federal and third-party payers that impact revenue generation and reimbursement.
• Informs staff of relevant changes and developments in payer requirements in a timely manner.
• Ensures quality measurements, such as charge audits and compliance driven reviews, are in place.
• Identifies and implements revenue cycle process improvement activities.
• Supervises the development of and enforces all relevant revenue cycle policies, procedures, and operating guidelines. Ensures that information is adequately communicated to staff, is monitored for effectiveness, and changed as needed.
• Maintains and promotes excellent collaboration with all revenue cycle key stakeholders and departments.
• Assesses priorities, work activities and allocates resources appropriately.
• Establishes and maintains long-term customer relationships, building trust and respect by consistently exceeding expectations.
• Facilitates and organizes collaboration efforts with IT on all system upgrades/testing etc.
• Leads and/or serves on hospital revenue cycle committees, teams, and work groups as required.
• Adheres to internal controls and reporting structure.
• Performs related duties as required.

Knowledge/Skills/Abilities:

• Knowledge of CDM, regulatory compliance, ICD-10, and CPT-4 medical record coding and UB04 billing.
• Knowledge and understanding of payer reimbursement procedures and methodologies
• Adept at utilizing electronic medical record systems, preferably Epic, as well as the Microsoft 365 productivity suite
• Demonstrates effective communication skills: speaks and writes clearly, conveys information in a concise, organized, and logical manner; ability to effectively present information to leadership, and/or board of trustees; listens attentively and exercises tact, discretion, and diplomacy when interacting with members of the department and organization.
• Demonstrates strong leadership skills with an ability to work independently, motivate direct reports, set high performance standards and deliver quality services. Encourages the decision-making skills of staff managers and providing insight and leadership in complex situations.
• Ability to build effective teams/networks, working relationships, and alliances to collaborate effectively within department and organization, while working with all levels of staff within the organization.
• Ability to identify and define problems, collect data, establish facts, and draw valid conclusions that drives process improvement, quality, and productivity.
• Ability to read, analyze, and interpret common and technical journals, statistical reports, and other related documents.
• Knowledge and understanding of organizational policies, procedures, and systems. Ability to create new procedures and successfully develop and manage a budget.

Minimum Qualifications:

• Bachelor’s Degree in Business, Finance, Accounting, Health Care Administration or related field plus five (5) years of Revenue Cycle Management experience with progressive responsibility.
• Advanced certification including but not limited to: Certified Coding Specialist (CCS), Certified Coding Associate (CCA), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA).

Preferred Qualifications:

• Master’s Degree in Business, Finance, Accounting, and or Health Care Administration.
• Experience in billing/coding, collections, claims, and quality and integrity audit review.