Senior Director of Revenue Integrity

Position Summary:

• The Senior Director of Revenue Integrity leads strategic initiatives to maximize revenue capture, ensures billing compliance, and prevents revenue leakage.
• The Senior Director reports to the Chief Financial Officer.

District Responsibility

• Supports LVMC’s mission, vision and values.
• Demonstrates respect, professionalism, and courtesy to all patients, visitors, providers, and co-workers, as delineated in the LVMC “Commitment to Care”.
• Constantly uses C-I-Care principles when communicating with others.
• Demonstrates commitment to the quality philosophy and values of LVMC by maintain established policies and procedures, organizational objectives, continuous performance improvement, quality assessment, and safety standards.
• Participates in professional development.

Position Duties and Responsibilities:

• Guides the development and implementation of goals and objectives for revenue integrity programs including charge capture and denials management. Incorporates best practices and responds to emerging trends to enhance operations, programs, and services.
• Implements and evaluates revenue integrity programs, develops effective tools to measure performance, analyzes related data, prepares reports, and makes recommendations to senior leadership based on findings.
• Directs, supervises, and evaluates the work of Directors and departments responsible for:
• Revenue Cycle and related functions
• Coding and related functions
• Patient Access and related functions
• Clinical Documentation Improvement and related functions
• Develops and oversees the department budget in the aforementioned departments to meet District goals and objectives.
• Translates organizational plans, goals, and initiatives into applicable financial-related targets.
• Directs the development of Key Performance Indicators and reporting tools to monitor revenue performance and guide decision-making.
• Ensures appropriate staffing and coverage for revenue integrity functions.
• Directs and participates in the development, implementation, and consistent application of effective organizational policies, procedures, and practices as they relate to revenue integrity.
• Participates as a subject-matter expert and may lead or facilitate task forces, teams, and or councils to plan, implement, and coordinate programs, services, and/or activities for the organization.
• Maintains accuracy, compliance, and optimization of District’s chargemaster.
• Conduct and review audits of documentation and charge capture to ensure all services rendered are billed, preventing unbilled or missed charges.
• Assist Revenue Cycle Director with tracking of denied claims by type and payer to identify patterns, correct systemic issues, and appeal claims to prevent revenue loss.
• Assist Revenue Cycle Director in monitoring payments against negotiated fee schedules to detect and recover underpayments.
• Optimize technology, such as Electronic Health Record and billing systems, to automate charge reconciliation and identify anomalies in billing patterns.
• Collaborate with clinical staff to ensure documentation supports medical necessity and coding, reducing technical denials. Act as liaison between clinical departments and revenue cycle teams.
• Identifies revenue opportunities, analyzes financial variances, and leads internal/external audit readiness to mitigate revenue loss.
• Lends support to Operations Leadership in service-line analysis, ensuring accuracy and reliable of data inputs.
• Supports development and continued professional growth to meet company and individual goals for long-term success.
• Other duties as assigned by the Chief Financial Officer.

Essential Functions:

• The ability to meet all functions noted on job description.
• The ability to function unsupervised.
• The ability to work as a team.
• The ability to have positive personal interactions with staff, patients, visitors, and physicians.

Position Qualifications:

• B.S. or B.A. required; Master’s degree strongly preferred.
• Certifications: One of the following certifications is preferred: CHRI (Certification in Healthcare Revenue Integrity), CRCE (Certified Revenue Cycle Executive), CRIP (Certified Revenue Integrity Professional), RHIA (Registered Health Information Administrator), or RHIT (Registered Health Information Technician).
• Minimum of seven years of successful supervisory management experience in revenue integrity or related fields.
• Human relations and interpersonal skills necessary for interacting and negotiating with physicians, staff, and administration.
• Excellent verbal and written communication skills.
• LVMC reserves the right to modify the minimum requirements depending on the needs of the organization.