Director, Revenue Integrity

City / State

Norfolk, VA

Overview

Work Shift

First (Days) (United States of America)

Job Summary

The Revenue Integrity Director leads a high-profile group responsible for ongoing maintenance and development of the charge description master (CDM) for all Sentara hospital facilities as well as Sentara Physician Groups, and charge capture structures / methodologies in Epic.

Ensures that all items on the CDM are a direct reflection of chargeable / billable services. This role requires a comprehensive understanding of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) guidelines and Medicare regulatory guidelines, as well as the understanding of Epic build and its related charge capture processes.

This role supports internal coding and charge audit functions and provides oversight to the responses for governmental audits such as HRSA and Third-Party Payer audits, participating in compliance related activities and clinical denial root cause analysis and process improvements.

Due to its service focus and project management emphasis, this position requires strong interpersonal and communication skills combined with superb analytic and organizational abilities.

The ability to meet deadlines while influencing but not directly managing the work of others is necessary.

Principal Duties and Responsibilities :

• Oversees Revenue Integrity leadership and staff as assigned.
• Initiate, coordinate, and implement all code and charge capture changes
• Recruit, mentor and coach Revenue Integrity leaders and staff at various levels of development.
• Lead and participate in complex projects related to revenue cycle initiatives.
• Collaborate with various departments throughout Sentara to integrate code and charge capture related functions and communicate changes to impacted teams
• Ensure that all charge documents and charge capture systems are updated to allow for accurate coding and charge capture.
• Communicate and coordinate training for charge processing changes to clinical departments
• Execute post implementation audits on chargemaster changes
• Perform quality audits related to analyst work product.
• Develop, maintain and implement department training materials.
• Develop, maintain and implement a Quality Audit Program and associated reporting.
• Work with Patient Accounting to ensure denials and billing errors related to the code and charge capture are addressed in a timely and accurate manner.
• Keep current on coding and chargemaster related issues through monitoring of the regulatory environment, review of literature, participation in professional organizations and continuing education.
• Execute on decisions made using sound judgment in dealing with compliance and regulatory issues.
• Develop and present recommendations for change. Obtain buy in from Senior Leadership Administrative Directors and Physician Leaders.
• Oversees special projects, implementations, and department initiatives as assigned.

Experience & Education Requirements :

• Bachelor's degree or equivalent.
• 10+ years' experience required

Qualifications :

BLD - Bachelor's Level Degree (Required), MLD - Master's Level Degree

Certified Coding Specialist (CCS) - Certification - American Health Information Management Association (AHIMA), Certified Professional Coder (CPC) - Certification - American Academy of Professional Coders (AAPC)

Epic Electronic Medical Record (EMR), Revenue Integrity

Skills

Active Listening, Communication, Complex Problem Solving, Critical Thinking, Monitoring, Service Orientation, Social Perceptiveness, Speaking, Troubleshooting

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.

gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.