Regional Director, Revenue Integrity & Optimization in Albany, NY

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Industry:

Hospitals & Medical Centers   •  

8 - 10 years

Posted 7 weeks ago

POSITION PURPOSE

Responsible for providing strategic leadership and oversight for the revenue integrity operations for the multiple hospitals and/or Medical Group Provider Services (MGPS) in the region. Directs and oversees the enhancement and development of processes and infrastructure for the following functions, including but not limited to, charge master maintenance, centralized charge control, pre-bill edits, appropriate revenue and reimbursement, including complex claims, contract specific bill-above reimbursement, payer audits and local RHM denial prevention and education. Accountable for fostering collaborative relationships with Payer Strategies, Revenue Integrity Central Operations, Reimbursement, Clinical Service lines, MGPS practices, and local RHM leadership. Collaborates with the Vice President Hospital Site Operations and/or MGPS Leadership on developing and directing strategic initiatives and facilitating standardization and optimization opportunities. Direct and oversees the identification and implementation of leading practices, processes and technology necessary to achieve objectives and engage key stakeholders by leading effective change management. Responsible for overseeing initiatives to improve net revenues, reduce receivables and improve compliance.

As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

ESSENTIAL FUNCTIONS

Knows and understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions

Directs and oversees the development of revenue capture processes and infrastructure, identification and implementaion of revenue and/or operational improvement processes and operating team providing financial information in a manner that is informative to organizational leaders for decision making purposes.

Directs, oversees and ensures regional performance and outcomes in the areas of revenue integrity including development and implementation of standard regional revenue integrity performance metrics and quality.

Directs, coordinates and synchronizes work efforts of geographically dispersed Revenue Integrity and Charge Control work teams ensuring adherence to established Standards of Excellence and ongoing monitoring of metrics and reporting of performance to senior leadership.

Collaborates with the Hospital Site Operations leader and/or Medical Groups Provider Services leader in the creation of strategic plans, goals and implementation plans for operations and highly visible and complex programs and projects. Directs and oversees the development and maintenance of departmental operating and capital budgets, which includes monitoring and analysis of performance metrics.

Responsible for serving as primary liaison with PBS leadership relative to revenue integrity and charge control functions. Collaborates with Payer Strategies and local RHM leaders to provide input in contract negotiations to eliminate the potential for denials and impact to gross revenue.

Directs and oversees human resource activities that include recruitment, completing appropriate documentation, performance appraisals and leading goal setting. Adheres to all human resource expectations for colleagues, including compliance related responsibilities, orientation and continuing education requirements, recognition of staff/team accomplishments, etc. Conducts annual span of control assessment for department.

Directs, oversees, and provides guidance and mentoring to Revenue Integrity and Optimization team. Responsible for motivating management team and colleagues which includes fostering encouragement and support.

Directs and oversees intradepartmental, interdepartmental and interdisciplinary committees/projects. Responsible for establishing positive relationships across multi-disciplinary departments that intersect and integrate with revenue management.

Oversees the management of all staff assigned responsibilities with a high level of accuracy in accordance with the established department processes including meeting all deadlines in a timely and proficient manner.

Responsible for accessing the impact of new programs, system implementations or modifications, and facility changes across the region and oversees the impact analysis on revenue, reimbursement, and established processes.

Responsible for serving as advisor to Revenue Integrity team and RHMs within the region on applicable regulatory and compliance rules. Directs and guides region to ensure compliance and optimal financial performance. Directs local Revenue Integrity leaders to ensure continuing regulatory and payer rules education process is in place for their team and stakeholders.

Maintains professional development, and growth and participates in appropriate committees and continuing education programs. Serves as a champion for change and improvement. Directs local leaders on problem resolution and corrective action for long-term solution and oversees efforts across intra and inter-departmental channels.

Maintains a working knowledge of applicable federal, state, and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

QUALIFICATIONS

Must possess a comprehensive knowledge of Hospital and/or Medical Group Provider operations, as normally acquired through the completion of Bachelor's degree in Finance, or Business or related field and a minimum of seven (7) to ten (10) years of progressively responsible experience in revenue cycle operations including revenue integrity and charge control or an equivalent combination of education and experience. Master's degree preferred.

Minimum of five (5) years of leadership experience in a multi-facility, integrated health care delivery system or revenue cycle or revenue integrity consulting experience.

Strong background in working with multi-disciplinary team, varying levels of leadership across the organization, including C-Suite and the demonstrated ability to be a change advocate, promote process improvement and ongoing education and growing the knowledge of team.

Exhibits strong leadership and management skills with the ability to attract, develop, deploy and retain an excellent revenue cycle team, capable of performing as a team and of evolving with the organization's vision and with cutting‑edge technologies.

Must possess strong analytical skills in order to detect and resolve problems related to accounts receivable and system implementations. Ability to address complex problems with multi-level impacts and with solutions not readily apparent and uses sound judgment, in depth analysis and expertise to resolve issues.

Ability to prioritize and deliver on key initiatives; demonstrated success in achievement of key performance metrics targets within time and budget constraints.

Ability to project a poised and confident demeanor and effectively communicates point of view , especially during stressful situations.

Must possess strong written and verbal communication skills and demonstrated ability to effectively manage department and communicate with a wide-ranging audience.

Demonstrated understanding and practical experience in project management, revenue cycle, technology infrastructure, integration, and related issues.

Previous Charge Description oversight strongly preferred. Knowledge of rules and regulations for hospital and professional charge capture and billing. Knowledge of hospital billing and claims systems.

Demonstrated ability to effectively work with a diverse group of people, which includes physicians, clinicians, office managers, administrators, third party payers, and governmental agencies .

Ability to understand and interpret complex issues and clinical processes and recommend improvements.

Excellent critical thinking, problem solving and decision making skills. Strong quantitative and analytical abilities to process and display data; including ability to interpret and explain data to varying levels of leadership and colleagues.

Must be comfortable operating in a collaborative, shared leadership environment.

Must be able to travel up to 50% to the various Trinity Health sites within the Region. May travel to RHMs outside of Region and System Office as may be necessary, typically under 10% of time.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.