Job Details: Summary of Position Description
Under the general direction and guidance of the VP, Revenue Cycle, the Director of Revenue Integrity is responsible for developing standards and ensuring the integrity of the integrated professional and facility revenue charge capture; includes all aspects of the Charge Master Description and fee schedule formulation(s), review and maintenance to optimize revenue generation, and maintain compliance with third party payer requirements; charge entry and reconciliation; collaboration with all service lines across the Maine Health Enterprise; policies and procedures development, modification and maintenance.The Director of Revenue Integrity also is responsible for developing a charge audit/capture/reconciliation process and ensuring charges are maximized for reimbursement. The Director of Revenue Integrity may provide oversight and insight for governmental audits such as RAC, MIC, etc. . . and Third Party Payor audits. The Director of Revenue Integrity also participates in compliance related activities.A key responsibility will be working closely with the CBO team to bring forth denials to clinical areas and leading process innovation based in lean management with these areas. Providing, projections based on historical data incorporation of (A3) root cause and Project management to these outliers.
Minimum Knowledge, Skills, and Abilities Required
- Education. Bachelor’s Degreerequired in Finance, Financial Management, Finance Administration, Nursing or Information System Management. Master’s degreepreferred.
- Certification. Certification in at least one of the following: CPC, CPC-P, CPC-H or Certification in Auditing and / or Healthcare Compliance. Must obtain or be working towards certification within one year of hire if not certified at time of hire.
- Experience. 5+ years of progressive revenue cycle with a focus on Denials, Coding, Billing or CDM.orAn RN with 2 years of business and a total of 5 years healthcare industry experiencerequired.
- Proficiencies. `Preferred: A3 process skills to develop root cause and corrective actions for teams`Lean process management skills `Must have excellent verbal and written communication skills in order to present and explain information to customers in a desired manner consistent with procedures. `Must have practical experience with Word, Excel, Powerpoint, and Access
- Specialized Knowledge. `Demonstrated knowledge of various hospital and professional fee coding systems including ICD-9/10-CM, CPT and HCPCS.`Demonstrated knowledge of the content, structure and maintenance of the Charge master and fee schedule/`Possess strong understanding of various reimbursement methodologies with expert knowledge of all payer billing requirements in both the facility and physician environments.`Strong quantitative, analytic, and problem solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions. Strong organizational skills to keep track of multiple priorities of highly detailed information`Ability to lead teams, mentor and support development of resources.
- `Must have professional and courteous skills.`Must have ability to make independent decisions.`Must have extensive knowledge of ethical and compliant business practices. `Must be able to handle sensitive, stressful and confidential situations and account information.