Director of Revenue Integrity

DEPARTMENT: REVENUE CYCLE

F ACILITY: Tift Regional Medical Center

WORK TYPE: Full Time

S HIFT: Daytime

The Revenue Integrity Director is responsible for providing direction and leadership to achieve ongoing quality, productivity and efficiency in the Revenue Integrity Department. Manages the enhancement and overall effectiveness of patient net revenue realization and minimizes revenue leakage for the organization. Oversight of charge master, charge capture activities, payer updates and denials management functions within Revenue Cycle. This position ensures effectiveness of the denial management team ensuring optimal performance in all areas of denial prevention and appeal processing in compliance with hospital policies and regulatory standards. Reviews and presents information regarding payer guidelines and assures appropriate processes in place to reduce risk and maintain compliance.

* Oversees charge capture operations of Southwell hospitals, clinics, and other physician/professional services.

• Develops, maintains, and updates policies related to developing charges, setting prices, capturing charges, charge capture monitoring and reconciliation; oversees and helps provide education on the same.
• Makes recommendations and oversees projects for net revenue and billing compliance optimization and monitoring.
• Ensures ongoing accuracy and integrity of the charge description master (CDM) and professional fee schedules by communicating and coordinating CDM information with the performing departments.
• Works collaboratively with revenue-generating department staff, physicians, and others to ensure sound charge capture process and that charges are thoroughly and consistently captured and documented.
• Oversees, implements, and performs monitoring and auditing activities to ensure integrity of charge capture.
• Reviews changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with applicable billing guidelines.
• Develops tools for the purposes of tracking and identifying potential areas of lost revenue.
• Educates staff regarding the appropriate application of edits related to CCI, medical necessity, etc.
• Assists in the resolution of problems causing payer denial or failed claim edits as they involve the charge master.
• Oversees a team focused on reviewing and, where appropriate, disputing/appealing clinical denials and charge audits by government entities (including CMS’s RAC audits) and contracted commercial payers. Ensures that any validated findings from such activity are communicated with the appropriate clinical and/or revenue cycle departments to continuously improve the effectiveness and accuracy of charge capture and billing.
• Interprets and communicates healthcare payment policies and practices and devises strategies to assure maximum reimbursement and minimize revenue leakage.
• Partners with Information Technology and other operational areas and leaders within the health system to implement strategies designed to improve the effectiveness of Revenue Integrity processes through increased automation and controls.
• Chairs monthly Denials Taskforce meeting and serves as a key stakeholder on the Revenue Cycle Steering Committee. Assists with managed care contracting reviews and provides payer updates.
• Keeps abreast of all pertinent federal, state and facility regulations, laws and policies as they presently exist and as they change or are modified.
• Ensures that the staff are trained and evaluated on their knowledge of and adherence to compliance policies and procedures specific to their jobs.
• Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
• Offers suggestions on ways to improve operations of department and reduce costs.
• Attends all mandatory education programs.
• Improves self-knowledge through voluntarily attending continuing education/certification classes.
• Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements.
• Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department.
• Volunteers/participates on hospital committees, functions, and department projects.
• Manages resources effectively.
• Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
• Makes good use of time so as to not create needless overtime.
  

* Bachelor's Degree

* Certified Revenue Cycle Representative

• Certified Revenue Integrity Professional