MHS - Revenue Cycle Leadership - Director_Revenue Integrity

Mosaic Life Care•Saint Joseph, MO

18h

About The Position

Under the direction of the Vice President of Revenue Cycle, the Director of Revenue Integrity oversees the Revenue Integrity Department. The Director is responsible for supporting the enhancement and maintenance of properly functioning revenue capture processes at Mosaic Life Care. The Revenue Integrity Director works across the organization, collaborating with Managed Care, Finance, Technology Services and clinical teams to ensure accurate, timely and compliant revenue posting and reimbursement. Provides guidance and oversight for charge description master integrity, patient account charge audits, regulatory audits and appeals, underpayment recovery and denials management for hospital and physician clinic services. Supports and manages the technical charge capture systems, processes and workflows of revenue generating departments for the organization to ensure timely and accurate recording of revenue, in accordance with all applicable governmental and institutional standards, bylaws, rules and regulations. Provides information to charge capture teams and operational directors/managers related to mechanisms of charge triggers, controls and reconciliation, and coding purposes of compliant billing and charging procedures. This position is responsible for developing and implementing price setting methodology and procedures. This position aims to maximize operational efficiency by supporting staff functions and promoting the integrity of the revenue charge capture system. To achieve these goals, the Director of Revenue Integrity identifies opportunities to work with leaders in other organizational areas – including compliance, clinical service lines, case management, Patient Access, Patient Financial Services and other departments – to ensure regulatory compliance, increase care coordination, and improve communication among departments. Principle responsibilities will also include directing the overall functions of assigned areas across the continuum to support quality, cost and satisfaction outcomes; assuring department is appropriately staffed and providing performance feedback, assure appropriate management of Revenue Integrity, and all other utilization functions. This leader interacts with leadership and front-line caregivers across the organization to accomplish department goals and assures that department objectives align with Mosaic's Mission/Vision/Values and Strategic Priorities. The leader is also responsible for designing and leading an integrated (enterprise) Revenue Integrity services. Direct reports include; Revenue Integrity Manager and underpayments team.

Requirements

Experience in revenue capture processes.
Experience with charge description master integrity.
Experience with patient account charge audits.
Experience with regulatory audits and appeals.
Experience with underpayment recovery.
Experience with denials management for hospital and physician clinic services.
Experience managing technical charge capture systems, processes, and workflows.
Knowledge of applicable governmental and institutional standards, bylaws, rules, and regulations.
Experience developing and implementing price setting methodology and procedures.
Experience working with leaders in compliance, clinical service lines, case management, Patient Access, Patient Financial Services, and other departments.
Experience directing overall functions of assigned areas to support quality, cost, and satisfaction outcomes.
Experience assuring appropriate staffing and providing performance feedback.
Experience managing Revenue Integrity and other utilization functions.
Experience interacting with leadership and front-line caregivers.
Experience designing and leading integrated (enterprise) Revenue Integrity services.
Experience managing direct reports including a Revenue Integrity Manager and underpayments team.

Responsibilities

Oversees the Revenue Integrity Department.
Supports the enhancement and maintenance of properly functioning revenue capture processes.
Ensures accurate, timely and compliant revenue posting and reimbursement by collaborating with Managed Care, Finance, Technology Services, and clinical teams.
Provides guidance and oversight for charge description master integrity, patient account charge audits, regulatory audits and appeals, underpayment recovery, and denials management for hospital and physician clinic services.
Supports and manages technical charge capture systems, processes, and workflows of revenue-generating departments.
Ensures timely and accurate recording of revenue in accordance with all applicable governmental and institutional standards, bylaws, rules, and regulations.
Provides information to charge capture teams and operational directors/managers related to mechanisms of charge triggers, controls, reconciliation, and coding purposes of compliant billing and charging procedures.
Develops and implements price setting methodology and procedures.
Maximizes operational efficiency by supporting staff functions and promoting the integrity of the revenue charge capture system.
Identifies opportunities to work with leaders in other organizational areas to ensure regulatory compliance, increase care coordination, and improve communication.
Directs the overall functions of assigned areas to support quality, cost, and satisfaction outcomes.
Assures the department is appropriately staffed and provides performance feedback.
Assures appropriate management of Revenue Integrity and all other utilization functions.
Designs and leads integrated (enterprise) Revenue Integrity services.
Manages direct reports including the Revenue Integrity Manager and underpayments team.