Director, Revenue Integrity

Job Summary

The Director of Revenue Integrity is responsible for leading and optimizing the revenue cycle to ensure accurate and compliant billing, coding, and collection practices, maximizing revenue and minimizing financial risks for the organization. This role involves developing and implementing strategies, training staff, and monitoring revenue trends to identify areas for improvement. Identify and implement process improvements to optimize revenue cycle efficiency and reduce revenue leakage. Develop and deliver training programs for staff on coding, billing, and revenue integrity principles.

Duties/Responsibilities

Identifies and implements process improvements to optimize revenue cycle efficiency and reduce revenue leakage.

Oversees the development and execution of reimbursement policies and practices to improve revenue cycle processes and procedures.

Documents the end-to-end process of revenue cycle workflows to help standardize processes, improve efficiency, and facilitate training for employees.

Manages revenue cycle projects including the planning, organizing, tracking progress and completion of projects to enhance the revenue cycle.

Develops and delivers training programs for staff and providers on documentation, coding, billing, and revenue integrity principles.

Leads and oversee organization-wide Revenue Integrity and vendor charge capture functions.

Ensures vendor integrates pricing and charge capture processes for all revenue cycle operations across organization.

Assists clinical departments with the deployment, as well as continuous performance improvement efforts, for accurate and compliant charge submission. Drive execution and transformational change and leading-edge operations to contribute to the financial success of GWmedicine.

Manages development of policies tailored to GWmedicine clinical operations to ensure organizational best practices.

Oversees annual price adjustment process through pricing models and vendor contract management variance reporting.

Oversees vendor charge integrity, reconciliation, late charge monitoring, and charge interfaces for all ancillary charging systems.

Collaborates with billing vendor to establish and maintain charge capture audit processes, to check for appropriate coding and areas of potential revenue leakage; collaborate with Department leadership on improvement opportunities.

Acts as a conduit between the billing vendor and the Finance team to ensure that revenue recognition in Epic system is appropriately accounted for in our General Ledger.

Oversees the development and execution of monitoring tools to ensure effectiveness of revenue cycle projects and processes related to revenue capture (timeliness of charge capture, DNFB, etc.).

Oversees Revenue Cycle vendor with revenue related compliance policies, processes and tools, including analysis and interpretation of federal, state and local laws and regulations.

Represents GWmedicine to third party payers and regulatory agencies regarding reimbursement practices, policies, and regulations.

Other duties as assigned or required.

Supervisory Responsibilities

n/a

Education

Bachelor’s degree in business/healthcare administration and/or equivalent combination of relevant work experience.

CPC (Certified Professional Coder) certification or relevant coding experience.

Licensure/Certification

CPC (Certified Professional Coder) certification or relevant coding experience.

Experience

Minimum of 10 years’ experience in a large academic group practice with emphasis on revenue cycle operations, revenue metrics and analytics, and revenue management or equivalent combination of education and experience.

Minimum of 5 years’ CPC (Certified Professional Coder) experience and/or relevant coding experience.

Project management preferred

Skills/Abilities

Comprehensive knowledge of HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding)

Strong knowledge of accounting systems and insurance issues, healthcare industry issues and trends, legal issues in field of expertise, required third party and governmental guidelines, and work processing.

Knowledge in healthcare compliance including privacy and security regulations, confidentiality laws, access and release of information.

Must be fluent in Epic and able to manipulate large amounts of data.

Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel.

Strong analytical and problem-solving abilities and the ability to quickly and thoroughly analyze data and think strategically.

Project Management

Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of MFA necessary.

Strong attention to detail and follow-up; and ability to multi-task in fast paced, high-volume environment

Emotional intelligence and adaptability in new and/or ambiguous situations and challenging business environments

Physical Requirementsâ

Frequent mobility and/or sitting required for extended periods of time. Requires manual dexterity to operate computer keyboard, calculator, copier machine, and other equipment. Must be able to lift light to moderate amounts (i.e. training materials, etc.).