Director Revenue Integrity

Director Revenue Integrity

The Director Revenue Integrity will serve as a strategic leader and resource for the design, implementation, operation, maintenance, monitoring, and overall quality of the BSWH Revenue Integrity functions. Additionally, they direct a coordinated system-wide Revenue Integrity program to ensure BSWH compliance with Federal, State, commercial payor, and other applicable legal and regulatory requirements for the BSWH Revenue Cycle. This includes developing the overall department strategy, structure, productivity standards, metrics, policies and procedures. The Director Revenue Integrity is responsible for hiring, training, developing, and evaluating assigned direct reports as well as providing leadership support for the entire Revenue Integrity team.

Essential Functions of the Role :

• Ensures the accuracy of all key data elements of the Charge Description Master (CDM) (CPT / HCPCS codes, service descriptions, revenue codes, hard-coded modifiers, Relative Value Units, etc.) remain updated with all government and commercial payor coding and regulation changes through a system-wide CDM program for all wholly owned and operated hospitals, clinics, and employed medical groups.
• Provides oversight of the development of charge capture methodologies and processes in coordination with the BSWH Revenue Cycle, Coding, Corporate Compliance, and Information Services (IS) teams.
• Establishes and maintains effective lines of communication with both internal and external stakeholders. Sets strategy and provides guidance and advice throughout the system on all matters relating to Revenue Integrity.
• Serves as the definitive resource and point of contact to provide guidance and advice regarding the Charge Description Master (CDM) and charge capture related topics throughout the System to all BSWH key stakeholders (including, but not limited to, facility and department leaders, corporate leaders, Information Services, clinical teams, physicians, Informatics, and Revenue Cycle leaders). Partners with other Revenue Cycle, clinical, and Information Services departments to identify, research, and resolve charge capture issues. Maintains high-level knowledge of all charge capture methodologies, workflows, and processes.
• Develops a charging-focused educational strategy to ensure individuals involved in the Revenue Integrity process receive all necessary education, training, and resource materials to enable them to fulfill their responsibilities in an accurate and timely manner. This includes both the Revenue Integrity team as well as hospital / clinic stakeholders.
• Oversees a system-wide strategy to identify Revenue Integrity risk areas. Coordinates as needed with BSWH Internal Audit to develop, oversee, and coordinate a system-wide auditing and monitoring program of charging-related risk areas. Develops annual work plans, conducts audits, offers solutions and provides guidance to other BSWH teams in conducting audits, and oversees follow up activities.
• Oversees the development and execution of the BSWH Charge Reconciliation policy and procedure across all revenue generating departments. Responsible for establishing and providing support for a Charge Reconciliation audit program in line with the larger Revenue Integrity Audit program.
• Plans, directs, and coordinates ongoing monitoring and implementation of charge-capture related technology solutions across BSWH.
• Supports new hospital, department, service, and / or software implementations for the Revenue Cycle to ensure charge capture is performed accurately, consistently, and compliantly. Provides support to the Revenue Integrity team as they are reviewing regulations, designing, and reviewing charge capture workflow build, and ensuring post-go-live charge capture audits are performed and identified issues are mitigated.
• Develops and maintains system-wide Revenue Integrity policies and procedures. Periodically reviews policies and procedures and updates or adds new policies and procedures as needed.
• Performs other position appropriate duties as required in a competent, professional, and courteous manner.

Key Success Factors :

Qualifications :