Position Overview:

The Revenue Integrity Director has primary oversight of the revenue generating process and outcomes. Responsible for maintaining a strategic and leadership role for improving revenue results through oversight of administrative and financial processes, functions, and interdependencies from the provision of patient care to final payments. Responsible for developing an integrated coding and charge capture process between Physician services to facilitate standardization, efficiency, and proper outcomes. Develops strategic planning in support of leading practice to sustain coding, documentation, data integrity, revenue generation performance and outcomes. 

Essential Duties and Responsibilities: The following are general responsibilities associated with the job and are listed in order of greatest to least amount of time spent on the duties. 

• Define the vision, strategy, and priorities for all revenue integrity initiatives
• Support the Senior Director of RCM in related strategy development, planning, and execution
• Provide oversight to optimize coordination among CDM/Fee Schedule, RI Specialist, Audit and Clinical Documentation and Education within Revenue Integrity team
• Provide oversight to standardize the CDM, charge capture processes and procedures
• Identify relevant regulatory and contractual terms to direct appropriate actions in areas of payment disputes by performing appropriate reviews, investigating trends and patterns regarding charge capture, charge reconciliation and billing/coding guidelines
• Implement quality measures based on Physician captured charges and coding as well as patient care documentation to ensure compliance with pertinent regulations, guidelines, and industry benchmarks
• Oversee the dissemination of information regarding coding and reimbursement to the appropriate staff
• Oversees the training programs for coding to all staff as appropriate
• Develop, review, and maintain policies and procedures for Revenue Integrity
• Ensure adequate training and education is provided to Providers and practice staff regarding accurate charge selection/entry and documentation requirements
• Review, on an annual basis and/or as otherwise identified, CDM and/or fee schedule encounter forms, systems generating charges, reconciliation processes, CPT/HCPCS codes, ICD-10 codes and revenue codes for all areas treating patients to ensure all Physician billable charges are captured 
• Ensure the placement of controls holding providers and practice locations accountable for effectively managing the denial management and charge capture processes
• Oversee data analysis, trending, and management reporting to substantiate positive and compliant net revenue impact to the Physician services
• Oversee and manage payer relationships as related to audits, denials, and underpayments in coordination with the Managed Care department
• Collaborate with Acquisitions team for the onboarding of new providers and audit schedule
• Collaborates with Compliance, Business Office, Information Technology (IT) and Finance to facilitate proper coding and billing outcomes. 
• Oversees collaboration among Revenue Integrity practice to accomplish the following:
• Standardize CDM modification process to improve alignment between clinical services and third-party payer requirements
• Standardize charge capture, charge flow and charge reconciliation processes
• Establish routine charge capture and coding audits as well as feedback process
• Provide focused education to clinical and coding stakeholders
• Develop Key Performance Indicators (KPIs) to measure outcomes and document improved performance
• Provide essential quality evaluation, reports, advice, and improvement recommendations to management in all service lines 
• Maintain a high level of confidentiality and ethical behavior

Job may require other duties as assigned.

Education and Experience: The minimum level of education and experience required to perform the job at a satisfactory level.

• Minimum of 5-10 years of healthcare experience leading revenue integrity initiatives and/or building high performing teams consisting of CDM, coding, charge capture and data management SMEs
• Bachelor’s Degree in Business, Nursing or Health Administration required
• MBA or master’s degree preferred
• CPC, RHIT, CCS, or CMC coding credentials preferred

Knowledge, Skills, and Abilities: The minimum level of knowledge, skills, and abilities to perform the job at a satisfactory level.

• Demonstrates understanding of business and how actions contribute to company performance
• Demonstrates excellent customer service skills
• Extensive clinical operations and knowledge of charge creation, processing and reconciliation in a health care environment and experience with healthcare Physician billing, payment, and compliance practices as they relate to the establishment and management of charging systems and processes
• Strong analytical background with ability to translate, communicate and present, at an executive level, clinical and coding information
• Excellent communication skills and industry trending knowledge to facilitate physician and other stakeholders’ buy in process
• Relevant data and industry trending analysis to facilitate future strategic planning, e.g., service line development and management, physician engagement and buy in process
• Knowledge of EHR software systems and Microsoft Office products 
• Professional verbal and written communication skills
• Ability to develop reports and create presentations
• Ability to work collaboratively across disciplines and business lines.
• Must be comfortable educating staff members
• Ability to handle multiple tasks with excellent problem-solving skills
• Well organized with the ability to maintain accuracy and confidentiality

Key Performance Indicators & Productivity: The measurements used for the success of this position.

• Revenue Impact from Audit Findings
• CDM pricing impacts
• Charge lag
• Unbilled encounters
• Coding accuracy

Decision Making: Common decisions made in the job and the level of review or autonomy needed to finalize such decisions. 

• HIPAA compliance and Meaningful Use
• May make recommendations regarding policies associated with the job’s purpose and essential responsibilities.  

Work Environment: Environmental or atmospheric conditions commonly associated with the performance of the functions of this job. 

• General office conditions.

Physical Requirements: Activities that are commonly associated with the performance of the functions of this job. The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. 

• While performing the duties of this job, the employee is regularly required to stand and walk and sometimes sit; use hands to type, handle, or feel objects or controls; reach with hands and arms; and talk or hear.  
• Regular attendance is a necessary and essential function. 
• Travel may be required.