Bachelor's Degree in Business/Healthcare Administration or equivalent experience
Minimum 7 years of AR/Contract Management experience in healthcare specialties
At least 4 years of leadership experience
Experience in global service delivery
Responsibilities
Lead payer variance resolution and address underpayment issues
Communicate financial impact of underpayments to Client Success teams
Build relationships with payers for contract compliance
Oversee day-to-day operations and maximize cash recovery
Implement best practices for continuous improvement
Identify automation opportunities for efficiency gains
Monitor Revenue Integrity health and develop action plans
Benefits
Collaborative and fast-paced work environment
Opportunities for operational training and team development
Exposure to cross-functional leadership and stakeholder interactions
Potential for discretionary incentive bonuses
Opportunity to work across U.S. and India service delivery teams
Full Job Description
The Senior Director of Revenue Integrity leads the identification and resolution of payer variances and sets the strategic direction for assigned Revenue Integrity functions across Enterprise Service Delivery in the United States and India.
Essential Functions and Tasks
Payer Variance Resolution and Client Impact
Partner with Payer Contracting to address situations in which payers are not reimbursing clients according to contracted rates.
Communicate underpayment findings and their financial impact, including both volume and value, to Client Success leaders so information can be shared effectively with clients.
Build and maintain relationships with payers to resolve contract variances and support bulk appeals.
Operational Leadership and Process Improvement
Lead the day-to-day operations of Revenue Integrity, focusing on mitigating contracted underpayments and analyzing payer trends, workflows, productivity, and quality to maximize client cash recovery.
Implement and optimize best practices, policies, and standardized workflows through continuous improvement initiatives.
Identify automation opportunities to reduce manual touchpoints and improve efficiency.
Monitor the overall health of Revenue Integrity operations and develop action plans to address underpayments through data analysis and effective inventory management.
Use data and analysis to proactively identify trends and prepare executive summaries for leadership and Client Success teams.
Cross-Functional Leadership and Team Development
Foster strong interdepartmental relationships through collaborative communication, leadership, and end-to-end problem solving.
Oversee U.S. and India Enterprise Service Delivery relationships, productivity goals, and performance, and address gaps through appropriate remediation.
Work closely with Enterprise Service Delivery teams, Business Unit Presidents, and Client Success leaders to understand and meet client expectations.
Represent Revenue Integrity in presentations to payers, the Ventra executive team, and clients.
Provide direction and oversight for operational training for new and existing Revenue Integrity staff.
Maintain confidentiality of personal, financial, and medical information in accordance with HIPAA guidelines and Ventra Health policy.
Perform special projects and other duties as assigned.
Education and Experience Requirements
Bachelor's Degree in Business/Healthcare Administration or equivalent training or experience considered
At least seven (7) years AR Management/Contract Management experience in the areas of Emergency Med, Hospital Med, Radiology/Interventional Radiology, or Anesthesia/pain management preferred
At least four (4) years of leadership experience required
Global service delivery experience required
Knowledge, Skills, and Abilities
Knowledge of State, Federal, and Managed Care regulatory guidelines
Knowledge of benefit insurance billing and contract management
Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.
Strong oral, written, and interpersonal communication skills
Strong decision-making skills
Strong problem-solving skills
Strong time management skills
Basic word processing, spreadsheet, database, and presentation software skills
Basic mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages; and working with decimals
Ability to read, understand, and apply state/federal laws, regulations, and policies
Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately
Ability to remain flexible and work within a collaborative and fast paced environment
Ability to communicate with diverse personalities in a tactful, mature, and professional manner
Become proficient in the use of billing software within 4 weeks and maintain proficiency.
Understand and comply with company policies and procedures.
Compensation
Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.
This position is also eligible for a discretionary incentive bonus in accordance with company policies.
