Director Revenue Integrity

Prime Healthcare•Lewiston, ME

2d•Onsite

About The Position

The Director Revenue Integrity is responsible for strategic and operational leadership of the Revenue Integrity department. This position contributes to the financial strength, compliance and overall performance of Revenue Cycle operations by providing leadership for all Revenue Integrity functions, including hospital and physician (provider) services. The Director Revenue Integrity serves in a key role to monitor and facilitate improvement in the overall quality, timeliness, completeness, and accuracy of Revenue Integrity processes (such as charge master accuracy, charge compliance and accuracy, payment variance analytics and prevention and overall quality and accuracy of all data flowing through the revenue cycle). Data integrity and reporting of financial performance and impact of improvement initiatives and standard KPIs is required. The Director will ensure the effectiveness of Revenue Integrity policy, practices and technology platforms. Net revenue/performance improvement goal setting, monitoring and achievement are required.

Requirements

Bachelor’s degree required
Ten (10) years of experience in Finance or Revenue Cycle
Minimum of 5 years of experience in leadership roles
Detailed knowledge of privacy and security regulations, confidentiality / HIPAA, payer registration /authorization requirements, State Charity Care compliance, and MaineCare compliance regulations.
Working knowledge of Medical Terminology, Current Procedural Coding (CPT, HCPCS), Diagnostic Coding (ICD-9, ICD-10).
Expertise with regulations and accreditation standards, knowledge of specific state and federal requirements and standards.
Working knowledge of Medical Record, Financial Services and Healthcare Application technology.
Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in operations.
Able to effect collaborative alliances and promote teamwork.
Ability to ensure a high level of employee, patient, visitor, and external stakeholder satisfaction.
Effective organizational, planning, controlling, scheduling and project management abilities.
Effective managerial and administrative abilities as applied to the management of multiple projects.
Effective leadership abilities.
Financial acumen with ability to extract data, ensure integrity, produce reports and utilize for communicating results and affecting change.
Ability to positively influence change.
Excellent communications skills, both oral and written.
Demonstrated ability to work well with diverse people, excellent human relation skills.
Flexible and able to react to ever changing priorities.

Nice To Haves

Master’s degree preferred

Responsibilities

Provide leadership for all Revenue Integrity functions, including hospital and physician (provider) services.
Monitor and facilitate improvement in the overall quality, timeliness, completeness, and accuracy of Revenue Integrity processes (such as charge master accuracy, charge compliance and accuracy, payment variance analytics and prevention and overall quality and accuracy of all data flowing through the revenue cycle).
Ensure data integrity and reporting of financial performance and impact of improvement initiatives and standard KPIs.
Ensure the effectiveness of Revenue Integrity policy, practices and technology platforms.
Set, monitor, and achieve net revenue/performance improvement goals.