Director of Revenue Integrity - Full Time

Job:

Director of Revenue Integrity Classification:

Exempt/Salaried Job Summary:

Leads the Revenue Integrity team (CDM and Fee Schedule), HIM and Coding areas. Responsible for developing reporting and other analytics to identify opportunities or problems, process improvements, and other system changes; responsible for Chargemaster files and fee schedules. Partners with the contracting function with identification of payer issues, payer scorecards and payer meetings in partnership with contracting. Facilitates underpayment recovery processes and trend tracking. Leads denial management mitigation and under-payment efforts across TRMC. Facilitates TRMC Billing and Charging Council meetings and process for new service set-up and/or service charges.

Essential Functions:

• Facilitates the TRMC Billing and Charging council that oversees and implements new service/business start-up and service/business closures for the organization.
• Collaborates and aligns with leadership, vendors and staff across the revenue cycle to drive continuous improvement and ensure optimal revenue cycle efficiency and accuracy.
• Directs and coordinates the activities of Revenue Integrity service operations by mentoring and managing staff for superior performance that exceeds patient and customer expectations.
• Leads and directs Charge Master and Fee Schedule updates, pricing and maintenance activities.
• Leads and directs HIM/Coding staff and vendors in the hospital and clinic HIM, coding, CDI, provider charging and coding education and exceptional customer service.
• Leads and directs under-payment and denial mitigation efforts across TRMC. Including creating presentations to share the results of denial mitigation and underpayment analysis with Revenue Cycle leadership, Revenue Cycle vendor and Contracting.
• Define and meets revenue cycle performance goals and metrics. Evaluates performance and effectiveness of management, vendors and staff related to the applicable revenue cycle metrics and works to continuously improve performance, outcomes and timely and accurate record processing and coding.
• Develops partnerships between Revenue Integrity and revenue department heads for the dissemination of regulatory changes to ensure compliance and revenue integrity with government and non-government payers and charge capture requirements.
• Develops and oversees the delivery of education to revenue cycle, clinical departments and providers on chargemaster and fee schedule updates, Medicare Final Rule, accurate charge capture practices and charge reconciliation.
• Works collaboratively with Revenue Services staff, Finance and the Clinical Departments to continually analyze billing processes through developing trending, and modeling to ensure accurate and optimal revenue capture.
• Coordinates and oversees all retrospective, concurrent, internal and external revenue integrity audits.
• Assists in internal and external audits and ensures that coding activities are compliant with internal and external policies and regulatory standards, budget related performance and department specific functions.
• Defines and meets revenue integrity performance benchmarks. Evaluates the performance and effectiveness of management and staff against those benchmarks and works continuously to improve performance and outcomes.
• Provides appropriate levels of coaching to develop individuals/team skills and abilities to drive performance improvement.
• Develops and implements policies, procedures and training to guide and support service, and ensures orientation and continuing education for all areas of the Revenue Integrity department.
• Builds a collaborative team culture and ensures a high level of employee engagement and satisfaction.
• Manages and meets the operating and capital budget for assigned areas and prepares departmental financial, operating and performance variance reports.
• Reviews facility site needs including occasional onsite visits to proactively provide service and support and assesses the charge master and billing system for opportunities for optimal revenue capture and to incorporate standardized workflows.
• May provide information and analysis with vendor proposals and negotiations related to charge master compliance review and maintenance tools.
• Services as a technical resource in developing and documenting routine custom billing system tests, builds, and enhancements that will improve maintenance and/or prevent billing errors.
• Staff to the Revenue Cycle Steering committee, including development of the agenda, minutes, and project management of the follow-up actions from the committee meetings.
• Performs other duties assigned.
• Follows and adheres to TRMC vaccine policy(s) mandated by the Centers for Medicare & Medicaid Services (CMS).

Work Experience:

• 10 years in CDM, Fee Schedule, HIM and Coding and/or Revenue Cycle Management highly preferred
• Excellent reporting capabilities using various IT systems and Google products
• Excellent written and verbal communication skills because they are responsible for communicating with all levels of management to keep financial operations running smoothly.
• Analytical skills, as this will play a major role in job.
• RHIA or RHIT certifications through AHIMA preferred.
• CPT and IDT-10 coding knowledge or experience preferred.

Education:

• A bachelor's degree in Finance or Business-related field or equivalent experience preferred.

Physical Demands and Work Environment Lifting/Carrying Pushing/Pulling Lbs. % Time Lbs. % Time 1-10 34-66 1-10 34-66 11-20 01-33 11-20 01-33 21-50 01-33 21-50 01-33 51-75 01-33 51-75 01-33 76-100 01-33 76-100 01-33 Movement % Time Bend/Stoop/Twist 1-33 Crouch/Squat 1-33 Kneel/Crawl 1-33 Reach above Shoulder 1-33 Reach below Shoulder 1-33 Repetitive Arm None Repetitive Hand 1-33 Grasping 1-33 Squeezing 1-33 Climb Stairs None Walking Uneven 1-33 Walking Even 34-66 Environment % Time Indoors 67-100 Outdoors 1-33 Extreme Heat None Dusty None Excessive Noise 1-33 Equipment % Time Motor Vehicles None Foot Pedals None Extreme Heat None Dusty None Excessive Noise 1-33 Work near % Time Machinery None Electricity None Sharps 0-33 Chemicals 0-33 Fumes 0-33 Heights None Vision Depth Perception Required Color Not Required Peripheral Required Endurance Hours at Once Total in 12HR Sit 1 3 Stand 4 4.5 Walk 4 4.5