Under minimal supervision, the Director of Revenue Integrity role has responsibility and accountability for developing strategies and ensuring efficient and compliant revenue processes.
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 practices.
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.
Requirements
A Bachelor's degree in health care administration, finance, health information management, business or clinical degree (RN, pharmacist), or related field is required.
A Master's level degree is preferred
Fifteen (15) years of progressive responsibility in healthcare with at least Ten (10) years of increasing executive-level responsibility for multispecialty departments and multiple locations managing complex revenue cycle operations.
Master's Degree could satisfy 2 years of experience requirement.
- Highly prefer prior coding (HIM or Pro fee / Physician coding) experience, along with Charge Capture knowledge.
- Candidate must have extensive revenue cycle experience with advanced knowledge of revenue cycle, state and federal requirements (i.
e., charging, billing, price transparency), and a thorough understanding of the front, middle, and back-end revenue cycle practices.
- Healthcare Compliance Certification from HCCA is preferred
- Nursing or Clinical Care Experience is highly preferred
- Extensive knowledge in the field of revenue integrity practices and requires a clear and creative individual that ensures the methodologies employed sustain cash flow for the system while adhering to compliance with payer and regulatory regulations required to serve as subject matter expert.
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